FEDERAL (Accurate as of 02/14/2020)

Immigration

In late January, the US Supreme Court upheld the Department of Homeland Security’s updated rule expanding the criteria the government can use to determine visas or long term status of legal immigrants.  Specifically, it widens the definition of a “public charge,” an existing term describing individuals who may utilize government assistance. An applicant’s health status, education and employment levels will now be considered.  In addition, while previously only use of income assistance programs like Supplemental Security Income (SSI) or Temporary Assistance for Needy Families (TANF) could be considered, broader programs like food stamps, Medicaid, Section 8 housing and others will now be part of the review process. These changes will particularly impact poor immigrants and those with health conditions or disabilities. 

Medicaid

On January 30, The Department of Health and Human Services issued guidance, called Healthy Adult Opportunities, to states regarding the Medicaid program.  It offered 1115 Demonstration Waivers as a vehicle to cut and cap state Medicaid health programs in exchange for wide latitude in program changes: eligibility, service array and quantity, prescription drugs, work requirements and more.  Medicaid, established 55 years ago, is a federal-state partnership providing health insurance to those who qualify. States have added optional services, including Home and Community Based Waiver Services (HCBS). 

Currently, states receive a federal match for every dollar spent. North Carolina receives just over $2.00 for every $1.00 it spends. States that opt to participate in either a block grant (lump sum) or per capita cap (funding for each enrolled individual) as outlined in the guidance, would lose that federal match and be solely responsible for cost overruns. While HCBS services are not specifically included in the guidance, they could be vulnerable to counteract state shortfalls.

Trump Administration Budget

President Trump released his fiscal blueprint for fiscal year 2021 on February 10.  Although this budget does not have the force of law, it outlines policy and fiscal priorities held by the administration, including cutting the Medicaid and Affordable Care by over $1 trillion dollars over 10 years, cuts to the Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) programs, 30% cut to Supplemental Nutrition Assistance Program (SNAP) also known as food stamps and more.  Various national stakeholder groups are preparing in-depth analyses at the time of this publication.

Social Security Administration (SSA)

The SSA sought comments through the end of January regarding its proposed rule to expand the use of continuing disability reviews (CDR) for Old Age Survivors and Disability Insurance (OASDI) and Supplemental Security Income (SSI).  It takes years for many beneficiaries to become eligible, and often requires professional expertise. This rule would increase the frequency of certification, likely adding to adjudication wait times and errors.

Voting

The Accessible Voting Act (S.3206) was introduced in the Senate on January 16.  Click here for details outlining ways this bill aims to decrease barriers to voting for citizens with disabilities.

STATE 

Legislative

The General Assembly convened on Tuesday, January 13 for one day and did not vote on the budget. At this point, the Senate does not have the votes to overturn the Governor’s budget veto. It is unlikely that the budget will be taken up when the legislature returns for the short session. We will most likely be waiting until after the November elections for movement on the budget. The key areas of contention remain the same – Medicaid expansion, education funding and tax cuts for businesses. As discussed previously, the budget contained funds necessary for the Medicaid transformation that had been planned to start in February.

Medicaid Transformation Update

Suspension of Medicaid Managed Care is still in effect. The decision to lift the suspension is dependent on legislative actions. Despite the suspension, the Department of Health and Human Services continues its work on policy related to the transformation. There are opportunities for public comment on this work. 

The most recent policy papers issued by DHHS are Behavioral Health I/DD Tailored Plan Request for Applications Pre-Release Policy Paper and Transition of Care Draft Policy 

The Tailored Plan RFA paper covers the processes the LME/MCOs will have to follow to apply to operate the Tailored Plan in their catchment area.  The LME/MCOs are the only entities that can apply for the RFA when it is released. The administrative and financial requirements are outlined, as well as expectations for building their networks for physical health and behavioral health and I/IDD services and supports. Outstanding concerns/questions include: Will rates be robust enough to attract physical health providers?  What type of training and support will physical health providers receive for caring for individuals with intellectual and other developmental disabilities (I/DD) in their practices? How will the state ensure there are I/DD providers who can deliver appropriate services and supports? 

This paper also outlines that the Tailored Plan will be required to have in-reach staff and transition staff to promote movement from ICF-I/DD facilities or state developmental centers to the community. This is a positive step; yet, the success of this will depend on the availability of appropriate services and support in the community.  

The Transition of Care paper sets out requirements for the Prepaid Health Plans (PHPs) to develop ways to ensure transitions in three areas: 1) transition from current system into the managed care system; 2) transition between PHPs; and 3) transition from a Standard Plan PHP to a Tailored Plan PHP. The goal of the DHHS is that the PHPs ensure continuity of care for each member and minimize the burden on providers during the transition. An important part of this paper is found in Appendix B which describes how people with I/DD who are in the Standard Plan, who are eligible for the Tailored Plan, are identified and supported, and transitioned to the Tailored Plan, if appropriate.  

The Department welcomes feedback at [email protected] 

NC DHHS Town Halls

The NC Division of Mental Health, Developmental Disabilities, and Substance Abuse Services (MH/DD/SAS) is offering a series of Town Hall meetings around the state with Deputy Secretary Kody Kinsley. The Town Hall meetings aim to provide MH/DD/SAS consumers, families, providers and advocates an opportunity to share feedback and experiences about ways to better support consumers and improve our public MH/DD/SAS services delivery. 

Check the NCCDD website for information on upcoming Town Halls.