HD42 - Private Youth and Single Group Homes in the Commonwealth

Executive Summary:
Established pursuant to HJR 685 of 2005, the Joint Subcommittee to Study Private Youth and Single Family Group Homes in the Commonwealth was directed to analyze the licensing requirements for such facilities and enforcement of such requirements, disclosure to local governments of licensure violations, concentrations of group homes in certain communities, the appropriate siting for group homes, and other issues that affect the integration of group home residents into the community.

The Joint Subcommittee held three meetings in which detailed information relating to the complex and difficult issues concerning group homes, particularly, children's group homes and residential facilities, were addressed. During the meetings, extensive data was received on the Interdepartmental Regulation of Children's Residential Facilities, which is a coordinated effort of the Departments of Education, Juvenile Justice, Mental Health, Mental Retardation and Substance Abuse Services, and Social Services. This program, often referred to as "Core Licensure," is housed within the Department of Social Services and established in state statutes that are somewhat imprecise.

The study committee also received much data on the Comprehensive Services Act (CSA) program and the Department of Mental Health, Mental Retardation and Substance Abuse Services' licensing program for adult group homes. The numbers of group homes and their locations, investigations, disciplinary actions, and the causes for such regulatory responses were among the data presented.

The Department of Medical Assistance Services appeared before the study committee, explaining that congregate residential services (group homes) are offered under the Mental Retardation (MR) waiver, but do not include room, board, or general supervision. In fiscal year 2005, approximately 3,400 persons received the MR waiver services at a cost of approximately $173 million.

For the 2005 program year, 2,942 children were served in group homes funded by the Comprehensive Services Act for an average of 212 days during the year, with the average age of 15 years 8 months, 62 percent male, 38 percent female, 56 percent Caucasian, 40 percent African-American, and four percent Hispanic. The children were placed in the group homes by local departments of social services (60 percent), schools (16 percent), court service units (10 percent), the Fairfax interagency team (nine percent), community services board (four percent), and families and others (one percent). These total program year placements in group homes were made for behavioral issues, special education, emotional issues, caregiver incapacity, court involvement, and neglect.

Expenditures from CSA on group homes were $35 million or 13 percent of the CSA pool fund costs. Expenditures for residential treatment facilities were $93 million or 33.6 percent of the CSA pool fund costs. Thus, $128 million in CSA pool funds, i.e., 64 percent of the state general fund appropriation and an average of 36 percent of the local match, was spent on group home and other residential placements. Medicaid expenditures for CSA children for fiscal year 2005 were $54.3 million for residential treatment facilities and $2.8 million for group home services. Therefore, at least $185 million in state, local, and federal funds was spent on group home or residential placements of CSA children in FY 2005, not including other Medicaid and federal IV-E expenditures (foster care funds).

Representatives of local governments, advocates, service providers, and the public were invited to provide input to the Joint Subcommittee. Local governments expressed concerns about the lack of information on group homes, the public and residents' safety, across jurisdictional placements, training and qualifications of the group home staffs and operators, adequacy of group home services, the increased costs of police and emergency medical services calls, and group home operators' efforts to establish good neighbor and community relations.

Advocates emphasized the right of individuals with disabilities to live in the community and offered the suggestion that best practice guidelines can foster appropriate resolution of community issues. Service providers for both adults and children spoke to the growing need for community-based care. The service providers also provided evidence of being good neighbors and noted that the children and adults can be successfully served and integrated into the community in residential facilities. Private citizens voiced concerns about the effects of the development of group homes on neighborhood stability.

Briefings on relevant statutes and case law at the state and federal levels were provided to the Joint Subcommittee by staff. The federal Fair Housing Act prohibits discrimination against persons with disabilities "in connection with . . .[a] dwelling." Section 15.2-2291 of the Code of Virginia relates to zoning ordinances and requires certain group homes to be considered single family residential housing. The occupancy standards in the Virginia Code have been interpreted to be floors and not to be caps by the Supreme Court of Virginia. Dispersal requirements have been addressed by several federal courts, with various results. However, the majority of the cases reviewed found density restrictions to be in violation of the Fair Housing Act.

During the work session in its final meeting, the Joint Subcommittee reviewed, discussed, and reached consensus on alternatives to address four broadly stated issues: (i) expediting implementation of certain 2005 approved legislation relating to group homes, (ii) regulatory requirements to improve the quality of group home services and enhance accountability, (iii) legal authority to summarily suspend group home licenses in situations threatening to the health and safety of the residents, and (iv) accountability in the Comprehensive Services Act program vis-a-vis reimbursement rates, placements across jurisdictional lines, and monitoring of services through site visits and utilization review.

The work session decisions were integrated into three bills that were introduced and approved during the 2006 Session: House Bill 577 (Nixon), relating to regulatory requirements for licensure of children's group homes and residential facilities, Senate Bill 190 (Martin), relating to suspension of licenses under certain circumstances, and House Joint Resolution 60 (Nixon), directing the Joint Legislative Audit and Review Commission to evaluate the administration of the Comprehensive Services Act.

In addition to this executive summary, a report will be published, detailing the work of and data collected by the Joint Subcommittee.