'People will die' if Kentucky doesn't find money for social services, lawmaker warns

Brenda Nichols said she has no regrets about taking five grandchildren into her small Valley Station home.

But Nichols, 59, a widow who lives on a small pension, said it's costly trying to provide for five kids ages 8 through 15.

"Day-to-day living is hard," said Nichols, who can't afford a car and shops at thrift stores for clothes. "I can walk to Walmart for groceries, but I'm not 20 years old anymore."

Nichols is among a growing body of Kentucky grandparents and other relatives urging the state to restore Kinship Care, a program the state closed to new applicants in 2013. It pays relatives $300 a month per child to care for children removed from homes because of abuse or neglect.

"Kinship Care would make such a huge difference," Nichols said.

And Kinship Care is just one of a host of human service programs competing for scarce dollars as the General Assembly starts planning the state's next two-year budget.

From infants born to drug-addicted mothers to senior citizens on waiting lists for Meals on Wheels, social service programs are straining under growing demand and shrinking resources. Many state programs have endured years of budget cuts dating to the start of the recession in 2008 and could face even more under a proposal by Gov. Matt Bevin, who has asked most agencies to calculate the impact of cuts of 17 percent in the current fiscal year because of a projected shortfall.

"It's just so bleak right now," said Rep. Jim Wayne, a Louisville Democrat who argues that Kentucky must find a way to generate more revenue to fund essential human services. "It's just unconscionable. People will die."

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Almost all government human services in Kentucky come under the state Cabinet for Health and Family Services — the largest cabinet in state government — which includes public health, mental health, public assistance such as food stamps, Medicaid, programs for the elderly and disabled, child abuse investigations and foster care.

With an annual budget of $13.5 billion — more than one-third of the state's total operating budget of $36.5 billion a year — the cabinet helps cover care for people ranging from newborns to the elderly in nursing homes.

Lawmakers haven't committed to additional funding but appear to understand the need.

Sen. Chris McDaniel, chairman of the Senate Appropriations and Revenue Committee, told cabinet officials at a recent budget hearing that money for human services is a priority.

"You guys take care of people early in life who aren't able to take care of themselves and you take care of people at the end of life," he said.

Many of the cabinet's costs are covered through the state's $10 billion-a-year Medicaid program, which provides health coverage for 1.4 million low-income or disabled Kentuckians and gets about 80 percent of its money from the federal government.

Bevin, who says the state's Medicaid program is "unsustainable," is working to scale back the program that covers nearly one-third of Kentucky's residents. But 16 months after he announced a sweeping plan to restructure Medicaid in Kentucky, his administration is still waiting on approval from the federal government.

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Meanwhile, state resources are limited as the agency faces growing demand in a poor state with an aging population, said Tim Feeley, deputy secretary of the cabinet, at a legislative budget hearing in October.

"The services we provide are critical to the citizens of Kentucky, and the demand for these services is growing every month,” Feeley said. "We serve the most vulnerable population and we do it on what is getting to be a shoestring."

Sen. Stephen Meredith, a Leitchfield Republican, suggested at a budget hearing in November that it's time to look at tax reform to better fund human services.

"The problem becomes quite obvious — there's not enough funding there," Meredith said. "We have cut our budgets almost to draconian levels. Something has to happen."

Because of money constraints and concerns about possible budget cuts, the cabinet has waiting lists for nearly all programs offered through its Department for Aging and Independent Living, including assistance for low-income elderly and disabled people meant to keep them at home, Feeley said.

"We make the best use we can of the few dollars that are available,” he said.

About 2,000 people are on a waiting list for home care services, which provides help with housekeeping, personal care and meals. Another 2,225 are on a waiting list for services such as home-delivered meals or meals at senior centers, according to the cabinet.

At the local level, officials are concerned they will feel the impact of any cuts in public funding.

Highlands Community Ministries in Louisville offers weekday meals to seniors at two sites and delivers meals to another 60 people. It also operates two child-care centers and one adult day center.

Troy Burden, executive director of the organization, said state spending cuts could hurt the ability to serve low-income people who rely on such programs.

"The state budget doesn’t affect us as much, but the state does have to match federal funds in order for these programs to work," Burden said. "If the state doesn't match, you lose the federal money. That's one of my biggest concerns right now with our senior centers and Meals on Wheels."

Advocates have long argued that services such as meals for seniors and personal care or housekeeping help older citizens remain in their homes.

Feeley said he understands that the alternative — going to a nursing home — is more costly and less desirable for an older or disabled person. And the state still winds up with the bill in most such cases, paying for nursing-home care through the Medicaid program.

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Nursing home care costs Medicaid about $1 billion a year to cover about 16,000 people, according to the state program.

“We are well aware of the fact it’s less expensive to have people in their own homes than in long-term care," Feeley told lawmakers at the budget hearing.

Meanwhile, long waiting lists remain for other state programs, such as help for people with severe brain injuries, even as slots for care go unfilled because of budget reasons.

Mary Hass, public policy advocate for the Brain Injury Alliance of Kentucky, said a state program partly funded through Medicaid is supposed to serve up to 350 people who need treatment and rehabilitation from a severe brain injury.

But at least 100 slots in the program are open and the state is not approving anyone for the vacant spots because of budget reasons, Hass said.

"No one's getting approved," she said. "The need is great."

A separate program for people who need long-term care for disabling brain injuries is at capacity at 350 with a waiting list of 200, Hass said. And people on the list must wait for years for a slot to open, Hass said.

Feeley said some state programs are straining to accommodate the need but can't refuse applicants or put people on waiting lists, citing the state guardianship program as an example.

By law, Kentucky must provide a state guardian for any adult deemed unable to handle personal affairs such as finances, health needs or housing if no one else is available.

The program has long been underfunded and overloaded. A state audit in 2008 found state workers were handling up to 60 guardianship cases each — triple the 20 cases per worker recommended by national standards.

In recent months the caseloads have increased to 70 to 80 per worker, Feeley said. And when judges appoint the state as guardian, the state can't turn clients away or put them on a waiting list.

The state has 4,400 people in the guardianship program with 61 workers to handle the increasing caseload.

"We're growing at a rate of about 30 cases a month," Feeley said. "It's just breaking the system."

Another program strained by soaring growth is the state's foster care system for children removed from homes because of abuse or neglect. Fueled in part by the state's opioid epidemic, the number of children in state care has reached 8,600, the highest in recent memory.

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And a federal court decision that said Kentucky must pay relatives who provide temporary foster care for children the same as it does for licensed foster parents has added to budget demands.

Adria Johnson, the state's social services commissioner, told a legislative committee in November that her department is still trying to determine how to implement the payments she estimates would cost up to $4 million a year.

Reinstating Kinship Care for new applicants would cost around $17 million a year, Johnson said.

Relatives such as Nichols, the Louisville grandmother, argue it would make more sense to pay relatives a Kinship Care stipend of $300 per month rather than foster care, which costs about $750 per month.

Nichols said the money would make a huge difference in her ability to care for her grandchildren.

Already caring for one grandchild, she and her late husband agreed to take in four more in 2009 when state social services officials removed them from their home because of addiction and domestic violence.

But six months later, her husband, a retired mechanic, died at age 55 from heart disease and left Nichols to raise the children alone on only half his pension. 

Nichols was able for several years to collect Kinship Care payments but lost them when she missed a filing deadline for paperwork in 2014 — a mistake she blames on the state for sending her application too late. The state refused to reinstate her because the program by then had been closed to new applicants.

Nichols wishes lawmakers understood how much it's affected her family.

"When they took that away, it was devastating," she said.

Deborah Yetter: 502-582-4228; dyetter@courier-journal.com; Twitter: @d_yetter. Support strong local journalism by subscribing today: www.courier-journal.com/deborahy.