LEXINGTON, Ky. — Before the pandemic, Fresh Approach had between 25 and 30 adults with intellectual and developmental disabilities at its adult day training program in Lexington.

The number of adults coming to the program has dwindled to eight on most days.

Lexington-based Employment Solutions operates several day training programs, including Fresh Approach. Prior to the coronavirus outbreak in March, it had 150 participants. Now it has just a quarter of that — roughly 40 to 50 participants.

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“When your business model is predicated on Medicaid funding and people cannot attend, obviously it affects your profitability, and as with any business, in order to continue to provide services, we have to have a funding source,” said Walter Barbour, director of Fresh Approach.

Most day training programs, which can provide exercise and arts classes, other activities and jobs to people with disabilities, are struggling across the state. Those programs closed from March until late June. When day training programs were allowed to reopen this summer, the number of participants plummeted. Many, like Fresh Approach, have had less than a third of their clients return.

At least two adult training programs have already closed, according to providers. Some adult training programs never reopened after the state-mandated closures in March. It’s not clear if those closures are permanent.

Others are on the brink of closing, said Amy Staed, executive director of the Kentucky Association of Private Providers, a nonprofit which represents more than 100 organizations that provide services to thousands of adults with intellectual and developmental disabilities in Kentucky.

“The rest are trying to figure out if they can make it,” Staed said.

Adult day training is paid for through Medicaid, a state and federal program for the poor and those with disabilities. The amount Medicaid pays for those services is low. To come out even, providers have to be at full capacity. But that’s not safe to do right now, Staed said.

Barbour said many people with intellectual and developmental disabilities have preexisting health conditions that make returning to congregate settings, such as the work-based program at Fresh Approach, impossible.

The state developed an assessment tool to determine if a program participant could come back to adult day training. That assessment tool screens out most participants, Barbour said.

‘Constant … worry’ as providers try to make numbers work

Kaleidoscope in Louisville is an adult day health center that provides day services for people with intellectual and developmental disabilities requiring medical care. It recently celebrated its 22nd anniversary.

But Tracy Ruth, its executive director and president, is worried that it won’t make it to its 23rd anniversary.

“We have 44 participants,” Ruth said. “We typically have 125.”

Kaleidoscope purchased additional cleaning supplies and brought back more staff to make it safe for those 44 participants to return. Costs have increased, but revenues have plummeted because the number of clients using the center has been dramatically reduced, Ruth said.

“It’s constant stress and worry every day,” Ruth said.

The Kentucky Association of Private Providers has asked the state Cabinet for Health and Family Services, which oversees programs for people with intellectual and developmental disabilities, to issue retainer payments for adult day training programs. Those retainer payments — typically based on a percentage of what a day training provider received at pre-pandemic levels — would help those day treatment providers stay afloat while operating at reduced capacity.

The Centers for Medicare and Medicaid Services, which oversees Medicare and Medicaid at the federal level, has issued guidance encouraging states to issue retainer payments during the pandemic to preserve the community-based day training programs.

Kentucky and Louisiana are believed to be the only two states that have not issued retainer payments or other types of payments to day training operators, Staed said. That information comes from other state-level organizations. However, Kentucky’s Health Cabinet leadership said 15 states, including Kentucky, have not issued retainer payments.

Any organization that receives a retainer payment cannot lay off staff and can be subject to audits, according to federal guidelines on those payments, Staed said.

Other organizations and providers have also floated increasing the Medicaid reimbursement — the amount providers are paid — to keep those providers running.

State says data on closures, financial impact not yet known

Barbara Fox, a spokeswoman for the cabinet, said the cabinet has not yet determined how many day training providers and adult day health care providers have shuttered since the pandemic began.

Fox said the cabinet has expanded how those providers can bill to help those programs stay solvent.

“We have modified services for which they can bill, such as the inclusion of home delivery of meals, virtual and telehealth options,” Fox said. Many adult day training and adult health care providers also have residential services. The state increased the amount residential providers received under Medicaid to help with increased costs.

“We are currently evaluating data which compares services delivered and paid since the state of emergency versus the same time last year to understand the fiscal impact on providers,” Fox said.

Not all providers may need help

Staed said the group is only asking for retainer payments for providers without residential programs. It’s not clear how many stand-alone adult day training or adult day health care centers are in Kentucky.

“We aren’t asking this for all providers,” Staed said.

Some adult day training programs have been able to offer some virtual or online programs.

But many people with intellectual and developmental disabilities can’t participate in virtual programs, Staed said. Moreover, outside of major cities such as Lexington and Louisville, internet access is too spotty, making virtual programming nearly impossible.

Many providers received payroll protection loans through the federal coronavirus relief funding during the pandemic’s early months. That helped providers for eight weeks. A second program for health care providers through the federal government also provided relief, but only for seven days, providers said.

“It covered one payroll,” said Ruth.

The state should have money in its Medicaid program to issue retainer payments, Staed said. Moreover, the federal government typically pays about 80 percent of Medicaid payments, depending on the program.

Providers aren’t charging Medicaid as much as prior to the pandemic, Staed said. Other typical services were not provided from March to June, and many of those providers are not operating at pre-pandemic capacity.

Over the past two decades, the state has worked hard to increase community-based services for people with intellectual and developmental disabilities. The pandemic could erase those gains.

Community-based programs for people with disabilities save taxpayers’ money, Ruth said.

“Everybody is not going to make it,” Ruth said. “And if we don’t make it, what will happen to the people who depend on us for services? It’s going to be a lot more expensive to send people to a nursing home or (residential treatment facility),” Ruth said.

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