Updated at 7:22 p.m. EST

A judge has ordered North Carolina to make it easier for people with intellectual and developmental disabilities to receive care at home rather than in institutions.

Disability Rights NC, which represented the plaintiffs in the case, called the ruling “historic,” while the state Department of Health and Human Services said the order could have negative consequences for people she tries to help.

The order was signed Wednesday by Superior Court Judge Allen Baddour and outlines several steps the state must take, including that the state must begin removing thousands of people with intellectual or developmental disabilities from facilities over the course of for the next eight years and stop admitting them. institutions, except for short-term stays within six years.

Background to the case

The case was originally filed in 2017 and involves a woman named Samantha Rhoney, who was born with developmental disabilities, movement disorder and other disabilities.

For many years, she lived at home with her family in Hickory, North Carolina, and received home care through the state Medicaid system.

As he got older, his home caretaker, Partners Health Management, began to scale back services through a process his lawyers called “fading”, in which rehab services are reduced to encourage a patient to live without them. .

As services were cut, Rhoney’s parents said they had no choice but to move their then 27-year-old daughter away from home to the J. Iverson Riddle Developmental Center to continue to receive care.

Her parents and other families with disabled children then sued the state, arguing that North Carolina violated the Individuals with Disabilities Act by needlessly institutionalizing people with disabilities and failing to provide them with care in the community as an alternative.

Judge orders state to take action

The judge in the case agreed with the families in a 2020 ruling and has now ordered North Carolina to take measurable steps to ensure people with intellectual or developmental disabilities can receive care at home or within a community framework if they so wish.

The order requires the state to expand its home care network and move thousands of people with intellectual or developmental disabilities out of institutions within eight years if they prefer to live in a “community setting.”

The state must also stop sending people with intellectual or developmental disabilities to live in institutions within six years – except for short-term stays or for stabilization.

Additionally, North Carolina needs to hire more direct social workers to administer community care and manage a backlog of more than 16,000 people with developmental disabilities waiting to receive home care through the NC Innovations Waiver program.

“The state has said for many years that it wants to serve more people in the community. We think this order is a big boost to move forward and do the things we all know we need to do,” said Lisa Grafstein of Disability NC.

State pushes back deadlines, other requirements

However, an appeal is possible.

Dave Richard, assistant secretary for NC Medicaid, told reporters on Wednesday that the state was concerned about the order’s “aggressive” timelines, and was particularly concerned about the requirement to stop long-term admissions to institutions. and health care institutions.

Richard said there are hundreds of small group homes in North Carolina that serve people with developmental disabilities. Many of them serve six people or less, Richard said, and preventing them from admitting long-term patients could put them out of business.

Richard was also concerned that the department would struggle to find enough direct social workers to handle the dramatic increase in home care needs, and said the department would also likely struggle to find housing for many people with disabilities.

“Frankly, the lack of understanding of the complexity of how our system works is concerning,” Richard said. “If the order is maintained, obviously that would be a huge boost for our department, our community vendors, trying to figure out the best way to handle this without harming individuals.”

Richard said the state is considering appealing with counsel from the North Carolina Attorney General’s Office and the North Carolina Solicitor General’s Office.