STATE UPDATE

Legislative

The Joint Legislative Oversight Committee on Health and Human Services met on February 15. The agenda included updates on COVID from Secretary Kody Kinsley (Department of Health and Human Services) and a presentation from Director Deepa Avula (Division of Mental Health, Developmental Disabilities and Substance Abuse Services) on Behavioral Health Services. Another meeting is scheduled for March 15.

The Joint Legislative Oversight Committee on Access to Healthcare and Medicaid Expansion met on February 18 and March 1. The first meeting focused on rural hospitals and the nursing shortage in North Carolina. The March meeting focused on Medicaid expansion and included a presentation by the National Academy for State Health Plans. This presentation covered facts about expansion and the potential benefits. NC is one of only 12 states that has not expanded Medicaid and has the sixth highest uninsured rate in the United States. Expansion has been shown to improve health outcomes and increase coverage for mental health and substance use treatment. This could save dollars that could potentially be used to increase services for people with intellectual and other developmental disabilities (I/DD). Another meeting is scheduled for March 15.

The North Carolina Council on Developmental Disabilities (NCCDD) will continue to follow the work of these committees.

1915(i)  Home and Community Based Services

The state continues to work on the service definitions for the 1915(i) Medicaid waiver. These services would create more options for people with developmental disabilities who are Medicaid eligible. The state’s goal for these services is that they will 1) take the place of the current (b)(3) services and 2) improve the service array for people with developmental disabilities. Key information about 1915(i) services:

• ‘i’ services are an entitlement for people who are eligible. So if someone meets the eligibility, they cannot be turned away or put on a waitlist.
• ‘i’ services will have limits on types of services and limits on hours.
• A person has to be Medicaid eligible due to income or SSI eligibility to receive (i) services.
• Individual does not have to meet institutional level of care (as with the Innovations Waiver).

The services that will be included under the (i) waiver include:

• Community Transition – services to help someone transition from institutional care to community living.
• Respite – can be at home or in a facility; can be planned or unplanned.
• Community Living and Supports – services to help someone live in their own home, family home, or home with other natural supports; similar to Innovations and state-funded service.
• Supported Employment – services to support competitive, integrated employment; matches Innovations and state-funded definitions.

The 1915(i) option will increase opportunities for home and community-based services.

NCCDD will continue to monitor this effort and expect a period for public input before the 1915(i) plan is submitted to CMS for approval.

Tailored Plan Care Management

As we move toward implementation of the Tailored Plan in December 2022, work continues to establish Care Management Agencies (CMAs) to provide care management for people with I/DD. Care Management is a multidisciplinary care team that provides whole-person care management that addresses: physical health, behavioral health, I/DD, traumatic brain injuries (TBI), pharmacy, long-term services and supports (LTSS), and unmet health-related resource needs. NCCDD along with other I/DD advocacy groups have pushed to include family navigation and peer support as a part of the care team. As a result, a definition of an ‘extender’ has been added to Care Management. An extender can be:

• Person with lived experience
• Certified Peer Support Specialist
• Parent/Guardian with 2 years experience
• Anyone with 2 years experience in ‘extender functions’

This is a positive step. Extenders are not required but encouraged to be included on the team. Rates do not fully cover costs of extenders, so Care Management Agencies (CMAs) may need to reduce use of CMs to offset costs. Despite these potential barriers, many providers have expressed interest in using extenders and have joined in advocating for their inclusion.

FEDERAL

State of the Union Address Includes Commitment to HCBS

On March 1, President Biden delivered his State of the Union Address in which he outlined his plans for a budget reconciliation package. President Biden referred to several parts of the Build Back Better proposal. In addition to highlighting the need to reduce the price of prescription drugs, the president also mentioned reducing costs of child care, providing universal pre-K for children ages 3 and 4, and providing long-term, in-home supports for older people and people with disabilities. This last point is referring to Medicaid home and community-based services.

Our continuing message to Congress is that we need a historic investment in home and community-based services to improve the quality of life for millions of people with disabilities, their families and the direct support professional workforce.

White House and Federal Agencies Outline New Actions to Keep People With Disabilities Safe During COVID

On February 24, the White House announced new actions to address the needs of people with disabilities during the COVID-19 pandemic and recovery. These actions include providing more guidance and supports to schools to keep students with disabilities safe, expanding the services provided by the Disability Information Access Line, making COVID-19 tests more accessible and distributing N95 masks to people with disabilities.