RICHMOND — Virginia has reached a wide-ranging settlement with the U.S. Department of Justice over its system for treating the intellectually and developmentally disabled, forestalling a federal lawsuit on charges the state needlessly institutionalized many people instead of placing them in community-based care.
The settlement comes on the heels of a scathing report issued by the Justice Department last February concluding that Virginia’s system violates the Americans With Disabilities Act.
Under the terms of the settlement, the state agreed to close four of its institutions that house people with intellectual disabilities, called “training centers,” and to downsize another. The settlement also requires Virginia to provide thousands of additional intellectual-disability waiver slots, which allow the state to waive the typical requirement that people receiving Medicaid funding live in institutions, enabling them instead to receive services in community-based settings.
“For decades we have said we ought to move to a community-based system for individuals with developmental disabilities and reduce our dependence on state-run training centers, the most costly and restrictive form of services available,” Gov. Bob McDonnell said in a statement. “While we have made progress and would have continued to make progress without this agreement, this agreement accelerates those efforts in a fiscally responsible and strategic manner.”
The settlement likely avoids a costly — and lengthy — legal battle. It involves $2.1 billion over the next 10 years — $1.1 billion in state general-fund money and $935 million in federal funds.
Secretary of Health and Human Resources William A. Hazel Jr. said the cost to the state could be whittled down to about $360 million through savings from closing the facilities.
“It has the potential to be helpful over time to the Virginia budget, which is something we all know we’ve been struggling with,” Dr. Hazel said, cautioning that the settlement should not be seen as a “victory lap.”
“Nothing is happening tomorrow. It takes time,” he said.
Virginia will close four of its training centers between 2014 and 2020, and the Southeastern Virginia Training Center in Chesapeake will downsize to 75 beds. The state will add 4,170 new intellectual-disability waiver slots over 10 years to transition people currently living in training centers to community services and to assist those who are on waiting lists. About 6,000 people are on waiting lists for community care.
The state will provide options for the more than 3,000 employees of the Department of Behavioral Health and Developmental Services, which operates the centers that are to close, [JUMP]Dr. Hazel said.
As part of the settlement, the state also must implement systems to deal with discharge and planning for patients and more frequent inspections of providers’ licenses and develop a statewide crisis system for people with disabilities.
For years, advocates have pushed for more waiver slots to transfer people from training centers to less costly community-based settings. The average cost per person at a training center is $216,000, and the cost per person with comparable needs in a community is $138,000.
But people who have family members housed in the centers say it would be impractical or impossible to take care of them outside that setting.
The agreement also stipulates that an independent reviewer will periodically review the progress to make sure the state is complying with the settlement.
In response to the findings letter last February, the General Assembly approved a $30 million trust fund to go toward transforming the system, and Mr. McDonnell, a Republican, has included another $30 million in his proposed two-year budget.
The investigation arose from the ADA and the 1999 Supreme Court Olmstead v. L.C. decision, which says people must be placed in the most integrated system appropriate to their needs. It began in 2008 at the Central Virginia Training Center in Lynchburg but was expanded in 2010 to cover the state’s entire system of services for people with intellectual and developmental disabilities.