COFAR blog

When Lara Dionne and her husband Martin attempted to bring their intellectually disabled daughter Keridwen from Maine to Massachusetts, they didn’t realize they would face a Catch-22-style series of bureaucratic rules and roadblocks from the Massachusetts Department of Developmental Services (DDS).

Keridwen has severe behavioral problems that require that she be placed in a secure setting, so the Dionnes requested a placement for her at the Hogan Regional Center in Massachusetts. She is currently living in an institutional facility in Maine.

However, DDS responded that it wouldn’t even consider whether Keridwen was eligible either for care at Hogan or for any other services until she was living in Massachusetts. DDS officials told the Dionnes they would have to bring Keridwen to Massachusetts in order for the eligibility determination process even to begin.

Keridwen Dionne

But, as we have reported, that eligibility determination process can take up to a year or more to complete. As a result, Keridwen would not have any services during that time, Lara said, and Keridwen and those around her would be at risk of harm due to her frequently violent behavior.

Yet, if the Dionnes were to leave Keridwen in the institution in Maine, the eligibility process for services for her in Massachusetts would never start.

“That scenario would effectively bar her (Keridwen) from ever moving to Massachusetts,” the Dionnes asserted in a statement filed with a DDS hearing officer who is considering their appeal to allow their daughter to be processed for eligibility in Massachusetts while she stays in the facility in Maine.

On top of all of this, as we have also reported, it is nearly impossible for adults with intellectual and developmental disabilities (I/DD), much less a 19-year-old such as Keridwen, to gain admission to either the Hogan Center or the Wrentham Developmental Center. That is because the doors to these two Intermediate Care Facilities (ICFs) have essentially been closed to individuals seeking admission.

The Dionnes say they are additionally facing pushback from the Salem School District, which funds care for district residents with intellectual and developmental disabilities who are under 22 years of age.

Lara and Martin, who moved to Salem from Maine last fall, are struggling to figure out how to get Keridwen moved closer to them safely. They said that because DDS won’t start the eligibility process, they also have no case management services for her in Massachusetts.

Massachusetts eligibility process takes a year or more

Lara said that when she first inquired about the Hogan Center, she was told she would need to apply first to DDS for eligibility for services. She said she was also told, at the time, that the eligibility process was taking 11 months.

Under DDS regulations, however, the Department must determine eligibility for supports and services within 60 days. But internal departmental emails, which we received from DDS, indicate that hundreds of individuals are being forced to wait for up to a year or more to be ruled eligible for those services.

The emails confirmed that DDS has been dealing with a backlog of eligibility applications due to a shortage of psychologists who are needed to make eligibility determinations on an individual basis.

DDS treated Keridwen’s application under adult regulations

DDS regulations actually allow for persons under 22 to be considered to be living in Massachusetts if one or both of their parents are living in this state. That is the case with the Dionnes, who both moved to Massachusetts from Maine last November.

But for reasons that have not been explained to them, the Dionnes said DDS is applying an adult eligibility regulation to Keridwen even though she is 19. The adult regulation states that the applicant for eligibility must reside in Massachusetts, regardless of where their parent lives.

The Dionnes, however, maintain that even under the adult regulations, Keridwen can legally be said to reside in Massachusetts as well as in Maine.

Since January 2023, Lara said, she has informed DDS that the family’s intention is for Keridwen to join the family in Massachusetts as soon as a suitable facility can be found for her. Keridwen stays with her parents in Massachusetts at least one weekend per month, and she has a bedroom in their home.

No response to request for a secure environment at Hogan

In early 2023, the Dionnes first inquired of DDS about applying for eligibility for services for Keridwen, and about “transitioning services between Maine and Massachusetts.”

In response, Erin Krol, the DDS Northeast regional eligibility director, stated on February 6, 2023, that, “Unfortunately, we do not have any means to transfer a person from one state to another.”

Krol added that, “an individual must apply for DDS eligibility in Massachusetts and go through the Eligibility process.” That process, Krol said, “requires the applicant to be domiciled in the Commonwealth of Massachusetts.” Only then, she said, could the Dionnes submit documentation “to proceed with the application.”

Lara responded to Krol with an email, saying, “We are not asking to jump the Massachusetts queue for services. We know there are waitlists. We are asking to get in those queues to transition her services safely.” She explained that her daughter has a history of behavioral issues, “including property damage and assault causing lasting bodily harm. I am not capable of caring for her alone.”

In June 2023, Lara emailed Kelly Lawless, DDS’s Northeast regional director, to express her and Martin’s desire for a placement for Keridwen at Hogan. She noted that only an ICF, which meets strict federal standards for staffing and care, could ensure her safety.

The following month, Lara wrote again, saying, “We hope that there is a children’s residential program appropriate to her (Keridwen’s) level of need in Massachusetts, but we have some concerns there. She is in an actual institutional setting currently.”

Lara noted in that message that, “we cannot bring her down here safely without placement in a treatment facility (and an educational facility) that has training in safe restraint, multiple staff on hand to execute such restraint, a medical team to address her psychiatric medications in a timely manner to respond to behavioral crisis, a secured physical environment which prevents access to hazards, and 24/7 staffing to cover any elopement attempts at night.”

In response, Krol suggested that the Dionnes “focus on getting (Keridwen) enrolled and placed appropriately in Massachusetts through the school district and then work with her team at Salem Public Schools on transitional planning for when she is 22 years old.” Lara said neither Krol nor Lawless responded to Lara’s statements about the need for a secure, ICF-level placement for her daughter.

Eligibility denied

The Dionnes applied for eligibility for DDS services in Massachusetts for Keridwen in November 2023. Only two weeks later, in December, DDS informed them that Keridwen had been found ineligible for services because she was “not domiciled in Massachusetts as per (the adult services eligibility regulation).”

The Dionnes appealed the eligibility denial, and had a DDS-sponsored “fair hearing” on March 13. Closing arguments in the appeal are due in late April. But the hearing officer is a DDS official, and the Dionnes said that as a result, they are not expecting that they will win their case.

DDS denial rests on definition of ‘reside’

As noted, the basis for the quick eligibility denial was the Department’s adult domicile requirement in its regulations (115 CMR 6.04). In an email in response to the denial, Lara contended to Lawless that “Domicile requirements for 5-22 year-olds are governed by 115 CMR 6.06 (the children’s eligibility standard under DDS regulations).”

In a subsequent statement filed with their appeal, the Dionnes maintained that, “No explanation is provided for why her (Keridwen’s) eligibility was not evaluated on the basis of children’s supports. Nor does it indicate what aspect of the domicile requirements were unmet.”

The Dionnes argued that even under the adult regulations, Keridwen could be considered to reside in Massachusetts. As noted in Black’s Law Dictionary, they stated,  “A person domiciled in one state may, for temporary reasons such as health, reside for one or more years in some other place deemed more favorable.”

The Dionnes noted that the DDS regulations do not state that the person must “reside solely in Massachusetts,” nor do they specify any limits on how much of the time they must reside here.

“To deny eligibility for DDS services based on a more restricted interpretation of ‘reside’ would create an untenable paradox,” the Dionnes stated. “We cannot safely relocate Keridwen to Massachusetts without continuity of care. And yet we would not be able to arrange those services without her first relocating to Massachusetts. That scenario would effectively bar her from ever moving to Massachusetts.”

No response from the administration

Lara said that in addition to making their case to DDS, she and her husband have contacted the Executive Offices of Health and Human Services and the Governor’s Office of Constituent Services, and sent them “multiple calls, emails, and a letter with supporting documentation.” She said they have not received a response from either office.

The Massachusetts Attorney General’s Civil Rights Division, which the Dionnes had also contacted, did respond with a letter stating the Division was “not able to assist in resolution of this matter.”

Unfortunately, the direction this case has taken is not surprising. DDS has declined to accommodate this family, which is clearly in need of the Department’s help in a difficult situation. The Department has instead placed a priority on its policy of keeping the doors closed to the Hogan Developmental Center, a critical piece of the state’s infrastructure for persons with intellectual and developmental disabilities.

The Department has also interpreted its rules concerning domicile in Massachusetts in an unfavorable way with regard to the interest of this family. It applied an adult standard, without explaining its reasoning for that. Higher-ups in the administration, including the governor’s office, have not responded to the family.

The Dionnes said the Salem School District has similarly pushed back against their wish for residential accommodations for their daughter. In our view, the District is most likely doing this for budgetary reasons. Neither governmental entity – DDS nor the Salem Schools – appear to be acting on behalf of their most vulnerable constituents who need their help.

This is yet another reason why we are asking the co-chairs of the Legislature’s Children, Families, and Persons with Disabilities Committee to intervene with DDS, in particular, on behalf of some of the most vulnerable members of our society. We hope we will receive a response from those co-chairs before it is too late for people like Keridwen and her family.