Advocacy Update: Budget Rushed and Private Medicaid Reform
Monday, September 22, 2015
Kay Castillo, Director of Advocacy, Policy, and Legislation
Legislators pushed a budget through to meet the Friday, September 18th deadline last week. The budget became public late Monday night. The very next day, Senators took a vote with little time to read through the plan. After House approval, the Governor signed the deal Friday afternoon. With the budget complete, legislators announced they have more than a week’s worth of work to get done and may not adjourn until early October.
Here are highlights from House Bill 97, and the accompanying Money Report. Page numbers can be found in House Bill 97 and pages beginning with a letter can be found in the Money Report (ie G-4, I-5, etc.).
Health and Human Services
- Sets up $225 Million per year for Medicaid Transformation/Reform. The logistics of reform are not in the budget as was outlined in the Senate proposal. We anticipate a bill to be taken up next week. Page 185. NASW-NC Supports reforming Medicaid with public accountability
- Funds the Child Welfare Education Collaborative at current levels. This provides training to social work students to go into child welfare careers. Page 186. NASW-NC Supports
- Fully restores cuts to the Home and Community Care Block Grant. This provides needed services to seniors such as meals on wheels, prescription drugs, mental health services, and more. Page 187 and G-4 of the Money Report. NASW-NC Supports
- Eliminates single stream funding from LME/MCOs. $110M this fiscal year and $152 million next fiscal year. This is very concerning as it will limit access to services and provider pay. Page 165. NASW-NC Opposes
- Transfers funds from Alcohol and Drug Abuse Treatment Centers (ADATC) to LME/MCOs over the next two fiscal years. This move will eventually get rid of ADATCs and LME/MCOs will be required to pay for this service. Page 168. NASW-NC Opposes elimination of ADATCs without a solid transition of services
- Dorothea Dix funding is allocated to the Mental Health Trust Fund in a separate account. Money spent is to be determined by the NC General Assembly but $25 Million is allocated to establish 150 inpatient beds across the state. Page 167. NASW-NC Supports funding from the sale of Dix Hospital to directly provide services
- Foster Care raised to age 21 for youth in care and a Social Services Program Coordinator position is created. Page G-7 of the Money Report. NASW-NC Supports
- Eliminates funding for pregnancy prevention or family planning unless contracted by Medicaid. Page 163. NASW-NC Opposes
- Provides funds to expand START (Systematic, Therapeutic, Assessment, Resources and Treatment) Team services to children and adolescents with intellectual or developmental disabilities and to add respite services for both children and adults. Page G-13 of the Money Report. NASW-NC Supports
- Provides funds to increase the number of TASC (Treatment Alternatives for Safer Communities) case managers who provide substance abuse assessment and referral services to criminal offenders who are maintained in the community instead of sentenced to prison or those who have been released from prison and are under supervision of a probation officer. Page G-13 of the Money Report. NASW-NC Supports
- Provides funding for Traumatic Brain Injury under a waiver in NC effective January 1, 2016. Page G-17 of the Money Report. NASW-NC Supports
Justice and Public Safety
- Funds 66 positions at Central Prison Mental Health Hospital to open 72 beds. Page I-4 of the Money Report. NASW-NC Supports
- Establishes mental health behavior treatment at eight close custody prisons. 4 units are funded fiscal year 2015-2016 and 4 units established the following fiscal year. Page I-5 of the Money Report. NASW-NC Supports
Other Budget Items
- Restores individual income tax medical deductions that largely impacted seniors and those with disabilities last year. This restoration comes after months of hard advocacy work. Page 5. NASW-NC Supports
- No cost of living raise for retirees. NASW-NC Opposes
- $750 bonus for all state employees. NASW-NC Opposes due to advocacy work on pay raises for all state employees
- Keeps tax exemptions for nonprofits. NASW-NC Supports
- Creates a new Department of Military and Veteran Affairs. Page 326. NASW-NC Supports
- Funds Achieving A Better Life Experience (ABLE) Act as outlined by House Bill 556. The ABLE Act provides for tax free savings accounts- 529 Accounts- for persons with disabilities in an attempt to ease financial burdens such as transportation, housing, education, health care, and more once a guardian has passed away. It’s a great solution for families who are worried about taking care of children with disabilities later in life. Page J-4 of the Money Report. NASW-NC Supports
Bills of Interest
House Bill 372 Medicaid Transformation: After much back and forth, legislators assigned a conference committee of House and Senate members to work on a compromised plan that was released last week. The bill allows for the development of three Prepaid Health Plans (statewide) and up to ten Provider-Led Entities (regional and the Department of Health and Human Services will develop six regions). The bill creates a new Division of Health Benefits under the Department of Health and Human Services and eliminates the Division of Medical Assistance (currently operating Medicaid in our state) after twelve months of the contracts being in place. However, the employees under the Division of Health Benefits would not be considered state employees. The plan has to be approved by the federal government which can take 18 months or more. Additionally, the plan requires that the current LME/MCO structure for providing behavioral health services be excluded until four years AFTER capitated contracts begin with Prepaid Health Plans. Managed care providers are responsible for all administrative functions, including grievances and appeals. Lastly, contracts with Community Care of North Carolina would be eliminated. Most likely, this bill will be approved by the General Assembly. We will continue working on logistics with the Department of Health and Human Services.
House Bill 373 2016 Presidential Primary: This bill moves all primaries in North Carolina from May up to March 15th, 2016. The bill was sent to conference committee to work out differences in the House and Senate and will most likely be voted on this week.
Senate Bill 279 Amend Qualifications/Practice Counseling: This bill changes a few things regarding the Licensed Professional Counseling license such as supervision and school accreditation but it also was amended last week to include language on teaching sex trafficking prevention and awareness. It also expands the list to who can teach sex education and now includes behavioral counseling.
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