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shows the home page of the Obamacare online health insurance marketplace

It’s Obamacare season. Here’s what you need to know.

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It’s Obamacare season. Here’s what you need to know. - North Carolina Health News

Open enrollment on the Affordable Care Act insurance marketplace goes until Dec. 15. Many people are confused about what plans might be best for them.

By Shefali Luthra

Kaiser Health News

During last week’s Democratic presidential debate, candidates touched on “Medicare for All,” “Medicare for all who want it” and other ways to reform the American health system.

But in the backdrop, it’s once again Obamacare sign-up season.

Despite repeated efforts by Republicans in Congress to undo the Affordable Care Act, the controversial law’s seventh open-enrollment period launched this month to relatively little fanfare. It ends Dec. 15.

North Carolina’s marketplace enrollment lags

Since open enrollment began on Nov. 1, 95,913 North Carolinians have signed up for health insurance on the health insurance online marketplace. That’s less than last year’s 114,114 enrollees after three weeks of signups, according to the Centers for Medicare and Medicaid Services.

Mark Van Arnam, director of the NC Navigator Consortium at Legal Aid of North Carolina said demand for health insurance has been steady, and in many places across the state, heavier than usual.

But he said Healthcare.gov glitches have slowed the sign up process statewide.

“Many of our navigators have had to spend longer times with consumers, reschedule consumers to come back at a later date, at which point we hope the glitch to be resolved,” he wrote in an email. “This has slowed the process a bit.”

Navigators will continue to help consumers through the Dec. 15 enrollment deadline, he said. People seeking assistance can call 855-733-3711, or visit NCNavigator.net to book an appointment with a navigator. 

Individual plans for 2020 are cheaper — premiums are lower, on average, and in some areas people who qualify for government subsidies could end up with no monthly payment.  Meanwhile, a pending court case threatens to overturn the entire law, with no clear replacement plan in the works. All these factors have combined to create a cloud of confusion and misunderstanding — some even say misinformation — about the availability of this health coverage.

Here’s what consumers need to know.

The ACA is intact — at least for now.

The Affordable Care Act is still the law of the land.

The GOP-led Congress gutted a key part of the law — the penalty for the individual mandate — that required everyone to have coverage. But other key tenets of the ACA remain in place, including the individual marketplace it created where people can shop for health coverage.

You might not hear much about that. The Trump administration has dramatically scaled back its outreach and marketing budget for the 2020 open-enrollment season — allotting about $10 million for such efforts, compared with the more than $100 million the Obama administration spent.

Lack of outreach, combined with Republican efforts to overturn or undermine the law, could give consumers a wrong impression, said Katie Keith, a health policy consultant who frequently writes about the health law.

So far, about 930,000 people have signed up for coverage. That’s still slightly lower than where things were last year — and first-day website glitches may have played a role, suggested Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms.

“The irony is, things are really stable, and depending on your state, you can really save,” Keith said. “Without advertising and information, folks are going to miss out on the deals they could get.”

You can get a cheaper plan this year, but it will probably require a bit of work.

Those deals can be pretty significant. On average, premiums are down 4 percent nationally over last year for silver-level plans sold through the federal marketplace. In some states, they’re even cheaper.

Many people don’t realize that if their incomes are below 400% of the federal poverty level (just under $50,000 for an individual or about $103,000 for a family of four) they qualify for federal subsidies — tax credits that help them pay for individual marketplace plans, Corlette said. The federal government has an online calculator that indicates whether you fall into this bracket.

That tax break can make it easier to find affordable, comprehensive coverage, Corlette said, and she recommended that people who have 2019 ACA plans shop around the marketplace to make sure they get the best deal going into 2020. (What plans charge can change each year.)

People who bought coverage last year and don’t shop around will be automatically reenrolled in their old plans — which may not be the best for their needs and may be more expensive than other options.

Also worth noting: Federal courts recently blocked a rule that would have penalized recent legal immigrants who use those subsidies. Known as the “public charge” rule, it would have counted that subsidy against people looking to stay longer in the United States.

The court ruling means that, at least for now, legal immigrants should also be able to purchase subsidized health insurance with no penalty, Corlette said.

“If you have concerns or are worried, you should consult an immigration attorney. But assuming you are a legal resident, nothing has changed in terms of your entitlement,” she said.

Not everything that looks like an Obamacare plan actually is one.

Consumers should be wary of plans that appear to meet ACA standards but actually fall short.

The Trump administration has loosened restrictions on non-ACA policies — “short-term plans” — so that they can last up to 12 months. (Previously they lasted only three months and were treated as bare-bones, stopgap insurance.)

Pitched as a cheaper alternative to ACA coverage, they are allowed to factor in preexisting medical conditions — and can reject people because of their medical history. They also generally cover a much narrower range of benefits. Some have lifetime caps on benefits, and they typically don’t cover prescription drugs.

These plans are not eligible for federal subsidies.

“If you were to Google something like ‘ACA plan’ or ‘Obamacare plan,’ the first results will return insurances that are not ACA coverage,” Corlette warned. “A lot of it is going to be junky, skimpy coverage.”

One easy way to distinguish ACA-compliant plans from others: Make sure you’re shopping through healthcare.gov or an alternative site set up by some states. Consumers who work with an insurance broker should be sure to communicate their desire to choose an ACA-compliant plan.

Meanwhile, federal courts are weighing a legal challenge that could strike down the ACA. It’s not clear what would happen if that transpired. For now, the case shouldn’t affect your coverage decisions.

A group of Republican attorneys general and governors filed a lawsuit in 2018 arguing that since the Supreme Court upheld the ACA in 2012 specifically because its individual mandate was deemed a valid exercise of Congress’ taxing power, reducing that tax to zero — as Congress did — makes the entire law unconstitutional. It’s an argument that many legal experts say is shaky, but a federal judge in Texas agreed with those who brought the suit.

The case, known as Texas v. Azar, is awaiting a ruling from the 5th Circuit Court of Appeals. The administration, meanwhile, has declined to defend the federal law. A group of Democratic attorneys general has stepped in, in their stead.

If the appellate court sides with the trial judge to overturn the law, the decision would likely be stayed and the case appealed to the Supreme Court. That could drag things out until next summer at the earliest.

The administration hasn’t indicated what it might do if the health law is struck down — a scenario that would gut the individual marketplace and eliminate the ACA’s consumer protections. But most experts agree it is also not likely to affect the 2020 coverage year.

Earlier this month, Joe Grogan, who heads the White House’s Domestic Policy Council, reiterated that the administration “will be prepared after that decision comes down” — adding that “nothing’s going to happen immediately.”

“This will surely go to the Supreme Court,” Grogan said. “It may or may not be decided, probably not decided, before the election.”

But it’s unclear what a White House response would involve. Neither President Donald Trump nor Republicans in Congress have put forth a health care proposal that would maintain the protections Obamacare put in place.

That could be worrisome down the line, Keith and Corlette said. But any impact is far enough away that it shouldn’t weigh on how consumers approach buying health insurance for the next year.

“Nothing will change right away, and it shouldn’t affect anybody anytime soon,” Keith said. “Go enroll. Pay your premiums.”

KHN correspondent Emmarie Huetteman contributed to this report.

legislative building in Raleigh

2019 Health & Human Services Budget – House & Senate

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2019 Health & Human Services Budget – House & Senate - North Carolina Health News

Just in time for the conference committee budget, here are how the Senate and the House of Representatives each proposed to spend on health and human services.

By Rose Hoban

After 2018’s unusual budget process this year’s budget has unfolded in a more “traditional” way. The House unveiled it’s proposal to spend $5.569 billion on health and human services priorities in early May. The Senate finished it’s work on the budget in early June, asking for a total appropriation of $5.552 billion for the same part of the state’s HHS budget.

Some of the big differences in the two budgets include across the board cuts to the Department of Health and Human Services, differences in block grant and nonprofit contractor funding and different earmarks to various lawmakers’ favored projects.

One notable trend over the past few years’ budgets is lawmakers’ increasing use of federal block grant dollars to supplant state dollars for large line items such as Smart Start and small ones, such as paying for adult protective services workers.

One similarity in the two chambers’ budgets is that neither body proposed expanding the state’s Medicaid program to cover people falling in the so-called coverage gap, those people who make too much to qualify for the program and too little to reach the level where they’d receive federal subsidies to buy insurance. Gov. Roy Cooper has been signaling for months that he was unlikely to sign off on any plan that did not include the expansion. With the erosion of veto-proof majorities in both chambers, it’s unlikely lawmakers will be able to override a Cooper veto, setting the legislature up for a standoff with the governor that could result in a long hot summer of negotiation.

As always, please feel free to let us know if we’ve made a mistake or missed anything. We’ve combed through hundreds of pages and it’s likely something escaped our notice!

HOUSE

SENATE

Division of Central Management and Support

Division of Central Management and Support
Allots $18.3 million for FY 19-20 and $12.3 million for FY 20-21 to match federal funds and speed development and rollout of software to track child welfare services case management. ($31.9 million allocated during FY 2018-19). Requires DHHS to report any changes to federal funding to legislature ASAP. Allots $18.1 million for FY 19-20 and $11.2 million for FY 20-21 to match federal funds and speed development and rollout of software to track child welfare services case management. ($31.9 million allocated during FY 2018-19). Requires DHHS to report any changes to federal funding to legislature ASAP.
Allocates $41.3 million in departmental receipts from FY 19-20 and $24.8 million in FY 20-21 to pay for above. Allocates $41.1 million in departmental receipts from FY 19-20 and $23.7 million in FY 20-21 to pay for above.
Continues new system for Community Health Grant Program created in the 2017 budget, limiting grants to community and rural health centers, local health departments, and school-based health centers that 1) have at least 80 percent of their population who are uninsured, on Medicare, Medicaid or SCHIP, 2) provide primary and preventive services to low-income populations, and 3) are intended to increase access to primary and preventive care services, including such things as creating new services or replacing facilities and equipment/technology. Continues grant cap of $150,000 per grant for coming biennium. Restricts the ways that grants can be used. Continues new system for Community Health Grant Program created in the 2017 budget, limiting grants to community and rural health centers, local health departments, and school-based health centers that 1) have at least 80 percent of their population who are uninsured, on Medicare, Medicaid or SCHIP, 2) provide primary and preventive services to low-income populations, and 3) are intended to increase access to primary and preventive care services, including such things as creating new services or replacing facilities and equipment/technology. Continues grant cap of $150,000 per grant for coming biennium. Restricts the ways that grants can be used.
Expands funding for the Home and Community Care Block Grant by $4.45M each year (mix of recurring and one-time funding) Expands funding for the Home and Community Care Block Grant by $969,549 each year in one-time funding, continuing last year’s spending level.
Provides $893,041 in additional (federal) Social Services Block Grant funds each FY to increase the number of Adult Protective Services workers in local county departments of social services. Total BG funding for APS: $2,138,434 Provides $457,041 in additional (federal) Social Services Block Grant funds each FY to increase the number of Adult Protective Services workers in local county departments of social services. Total BG funding for APS: $1,720,404
Appropriates an additional $700,000 to the Key Program, which provides funding to help develop housing for low-income people with disabilities. Total appropriation $6.9M (2017 budget: $6.2M) Appropriates an additional $700,000 to the Key Program, which provides funding to help develop housing for low-income people with disabilities. Total appropriation $6.9M (2017 budget: $6.2M)
Moves $7,295,643 in non-recurring funds in FY 19-20 from DHHS Transitions to Community Living Fund to the NC Housing Finance Agency for increased access to permanent, community-based integrated housing for individuals with disabilities in support of 2012 Olmstead Settlement. Moves $7,295,643 in non-recurring funds in FY 19-20 from DHHS Transitions to Community Living Fund to the NC Housing Finance Agency for increased access to permanent, community-based integrated housing for individuals with disabilities in support of 2012 Olmstead Settlement.
Provides $12,000/FY for the Senior Tar Heel Legislature No mention.
$200,000 to administer the DHHS Office of Rural Health to come out of the grant funds in each FY for administrative purposes. Requires the office to provide report on grants awarded to Joint Legislative Oversight Committee on Health and Human Services each September. Also orders a report, due November 2019, on the status of a Primary Care Advisory Committee, the process for funding the Community Health Grants, and development of outcomes measures for assessing the grants. $200,000 to administer the DHHS Office of Rural Health to come out of the grant funds in each FY for administrative purposes. Requires the office to provide report on grants awarded to Joint Legislative Oversight Committee on Health and Human Services each September. Also orders a report, due November 2019, on the status of a Primary Care Advisory Committee, the process for funding the Community Health Grants, and development of outcomes measures for assessing the grants.
Appropriates recurring funds of $1.5 million in FY 19-20 and $800,000 in FY 20-21 for student loan repayments for physicians and dentists in the Rural Health Loan Repayment Program. Appropriates $600,000 in FY 19-20 and $350,000 (non-recurring) in FY 20-21 for rural health loan repayments for nurse practitioners and certified nurse midwives. Along with federal matching grants, total for loan repayment: $3.7M in FY 19-20 Provides $3.5M in FY 19-20 and $1M in FY 20-21 in non-recurring funds for loan repayment for physicians, dentists, nurse practitioners and certified nurse-midwives to rural areas, no specificity to allocation of funds. Along with federal matching grants, total for loan repayment: $5.16M in FY 19-20
Adds $300,000/FY in funds for NC Telepsychiatry Program, expands network by two counties. Total for each FY now $2.12M Adds $500,000 in funds in FY 19-20 for telemedicine pilot program in Robeson County (not specifying telepsychiatry, but same budget line as House). Total for FY 19-20 now $2.33M, $1.83M in FY 20-21
One time allocation of $500,000 to NeighborHealth, a Christian-based safety-net health care provider in Wake County. In district represented by Cynthia Ball, funds come from “rural health infrastructure” line, total in FY 19-20: $20.2M, less than the required amount of $21.4M in the budget line. No mention.
Provides one-time funding of $250,000 to Surry Medical Ministries Foundation, a Christian-based free clinic in Mt. Airy, funding for capital improvements and operating expenses. District represented by Rep. Sarah Stevens. Funds come from “rural health infrastructure” line, total in FY 19-20: $20.2M, less than the required amount of $21.4M in the budget line. No mention.
Provides one-time funding of $250,000 to Davidson Medical Ministries Clinic, a full-service clinic, funding for capital improvements and operating expenses. District represented by Rep. Larry Potts. Funds come from “rural health infrastructure” line, total in FY 19-20: $20.2M, less than the required amount of $21.4M in the budget line. No mention.
Appropriates $400,000 in one-time funds during FY 19-20 and $350,000 in one-time funds during FY 20-21 for a veterans’ health care pilot program in Cumberland County to provide care and job training to vets. Funds come from “rural health infrastructure” line, total in FY 19-20: $20.2M, less than the required amount of $21.4M in the budget line. No mention rural health infrastructure expenditures, total in FY 19-20: $18.8M, less than the required amount of $21.4M in the budget line.
Eliminates the Office of Program Evaluation Reporting and Accountability, which was created in the 2015 budget. Reduces budget by $461,210 Eliminates the Office of Program Evaluation Reporting and Accountability, which was created in the 2015 budget. Reduces budget by $461,210
Allocates $400,000 in FY 19-20 and $350,000 in FY 20-21 to create pilot program to provide health care services to veterans in Cumberland County (near Ft. Bragg). Part of the program is a workforce initiative to train un- and underemployed veterans to become community health workers. Sets an end date for the program of June 30, 2021 and requires a detailed report be given to the legislature by February 2022 on expenses, how many people were trained and how veterans received care. No mention.
Eliminates the following “unnecessary and redundant” reports to the General Assembly: Report on the Expansion of Controlled Substances Reporting System Monitoring, Coordination of Chronic Care Initiatives, Compliance with Federal TANF Requirements, Report on Use of Lapsed Salary Funds Eliminates the following “unnecessary and redundant” reports to the General Assembly: Report on the Expansion of Controlled Substances Reporting System Monitoring, Coordination of Chronic Care Initiatives, Compliance with Federal TANF Requirements, Report on Use of Lapsed Salary Funds
Earmarks $250,000 in recurring funds each year to support the Advisory Council on Rare Diseases at the UNC Chapel Hill School of Medicine. Of this money, $30,000/year is budgeted for seminars around the state on rare diseases; $25,000 to support travel/per diem for Council members to attend the seminars; $5,000 for a website and social media; $160,000 for support positions and $30,000 for Council administrative support. No mention.
Appropriates $750,000 for the Miracle League of the Triangle to create a baseball diamond in Durham that would be accessible to people with disabilities. No mention.
Competitive grants for nonprofit organizations: Sets aside $11,153,911 in recurring funds for each year of the biennium, in addition to one-time funds of $450,000 per year. To provide these funds, $1.6M / year comes from the Substance Abuse Prevention and Treatment Block Grant and $4,774,525 coming from the Social Services Block Grant) to fund nonprofit organizations which provide services with state dollars. Sets out procedures, etc, for the organizations to receive the funds. Competitive grants for nonprofit organizations: Sets aside $10,653,911 in recurring funds for each year of the biennium. To provide these funds, $1.6M / year comes from the Substance Abuse Prevention and Treatment Block Grant and $4,774,525 coming from the Social Services Block Grant to fund nonprofit organizations which provide services with state dollars. Sets out procedures, etc, for the organizations to receive the funds.
No mention. Specifically sets aside $350,000/ year for Big Brothers Big Sisters; a total of $3.225M over the biennium for TROSA; $2.75M/ year to the Boys and Girls Clubs for dropout prevention programs; $250,000 over the biennium to Cross Trail Outfitters.
No mention. Creates a telehealth pilot program via the DHHS Office of Rural Health, appropriating $500,000 to Southeastern Regional Medical Center to develop the project in conjunction with providers in Robeson, Bladen and Columbus counties. Also sets out the timing and contents for a report on the project to be delivered in March 2021.
No mention. Inserts policy about connecting to the NC Health Insurance Exchange (HB 70), delaying the connection deadline for many small providers, mental health providers, state-operated hospitals to connect to NC Health Connex, the statewide health insurance exchange. Pushes deadline to June 2022.
Appropriates $200,000 additional funds for Medication Assistance Program which allows low-income and indigent patients to access prescription assistance programs run by pharmaceutical companies. Appropriates $200,000 additional funds for Medication Assistance Program which allows low-income and indigent patients to access prescription assistance programs run by pharmaceutical companies.
Gives DHHS the ability to move money from one vacant position and reduce other operating funds to achieve cost cutting mandated by the legislature. No mention.

Division of Child Development and Early Education

Division of Child Development and Early Education
Total NC Pre-K availability: $174.5M in FY 19-20, $187.4M in FY 20-21. General Fund outlay for NC Pre-K is $30.9M, includes moving $2.5M from TANF block grant, and adds $1.7M in annual funds to allow for increased NC Pre-K rates. Total NC Pre-K availability: $174.5M in FY 19-20, $183.8M in FY 20-21. General Fund outlay for NC Pre-K is $29.3M, includes moving $4.1M from TANF block grant, and adds $1.7M in annual funds to allow for increased NC Pre-K rates.
Moves additional $50 million in TANF Block Grant money into NC Pre-K, replacing General Fund dollars on a recurring basis, continuing  shift made initially in 2018. This swap out utilized $50 million from the Child Care and Development Block Grant to backfill NC Pre-K needs. Moves additional $50 million in TANF Block Grant money into NC Pre-K, replacing General Fund dollars on a recurring basis, continuing shift made initially in 2018. This swap out utilized $50 million from the Child Care and Development Block Grant to backfill NC Pre-K needs.
Establishes family income eligibility for NC Pre-K at 75 percent of the state median income, which maintains the current eligibility criteria for the program. Up to 20 percent of the children in the program may have family incomes above that if they have other risks. Also creates places for children of military or reserve members who are either on active duty, have been on active duty within the past 18 months, or are expected to be called up within the coming 18 months. Establishes family income eligibility for NC Pre-K at 75 percent of the state median income, which maintains the current eligibility criteria for the program. Up to 20 percent of the children in the program may have family incomes above that if they have other risks. Also creates places for children of military or reserve members who are either on active duty, have been on active duty within the past 18 months, or are expected to be called up within the coming 18 months.
Requires NC Pre-K to issue multiyear contracts for licensed private child care centers. Requires private facilities and public schools operating Pre-K’s to meet building standards, programmatic standards and classroom requirements. Also stipulates that local Pre-K committees use standard decision-making process developed by DHHS when allocating classroom slots. Sets a date and requirements for annual reports to the General Assembly. Requires NC Pre-K to issue multiyear contracts for licensed private child care centers. Requires private facilities and public schools operating Pre-K’s to meet building standards, programmatic standards and classroom requirements. Also stipulates that local Pre-K committees use standard decision-making process developed by DHHS when allocating classroom slots. Sets a date and requirements for annual reports to the General Assembly.
Allows for a 2 percent raise in the base reimbursement rate for child care centers participating in NC Pre-K over the FY 18-19 rate in the first year and by an additional 6 percent in the second year of the biennium. Allows for a 2 percent raise in the base reimbursement rate for child care centers participating in NC Pre-K over the FY 18-19 rate in the first year and by an additional 6 percent in the second year of the biennium.
Sets the following income limits for eligibility for Child Care Subsidy: for children ages 0 to 5 years, a family income below 200 percent of Federal Poverty Line; for children ages 6 to 12 years, a family income below 133 percent of FPL; for children with “special needs,” a family income of 200 percent of FPL. Sets cost sharing rates, based on 9 percent of family income. Sets new standards about cost sharing for families, requiring that care received at blended rate, that the copayment will equal 83 percent of the full-time copayment, equal 75 percent of the full-time copayment for part-time care. Sets the following income limits for eligibility for Child Care Subsidy: for children ages 0 to 5 years, a family income below 200 percent of Federal Poverty Line; for children ages 6 to 12 years, a family income below 133 percent of FPL; for children with “special needs,” a family income of 200 percent of FPL. Sets cost sharing rates, based on 9 percent of family income. Sets new standards about cost sharing for families, requiring that care received at blended rate, that the copayment will equal 83 percent of the full-time copayment, equal 75 percent of the full-time copayment for part-time care.
Religiously sponsored centers meeting the minimum licensing standards will be paid the one-star county rate OR the rate they charge private pay parents, whichever is lower. Religiously sponsored centers meeting the minimum licensing standards will be paid the one-star county rate OR the rate they charge private pay parents, whichever is lower.
Centers and homes earning 2+ stars will receive the market rate or the rate charged to private pay parents, whichever is lower. Centers and homes earning 2+ stars will receive the market rate or the rate charged to private pay parents, whichever is lower.
Requires market rate to be calcluated for each license level in each county, age group and category of enrollees. Orders DCDEE to calculate a statewide rate and regional market rate in each category. Mandates quality improvement activities on the part of DCDEE and oversight of facilities. Limits a county’s ability to reduce a provider’s rate. Allows for Department of Defense certified facilities to participate in the program. Requires market rate to be calcluated for each license level in each county, age group and category of enrollees. Orders DCDEE to calculate a statewide rate and regional market rate in each category. Mandates quality improvement activities on the part of DCDEE and oversight of facilities. Limits a county’s ability to reduce a provider’s rate. Allows for Department of Defense certified facilities to participate in the program.
Children of noncitizens are eligible for child care subsidy if the child is in foster care or developmentally delayed or if the child is a citizen. Children of noncitizens are eligible for child care subsidy if the child is in foster care or developmentally delayed or if the child is a citizen.
Raises the base reimbursement rate for child care centers in the Pre-K program, allowing for a 2 percent raise in the first year of the biennium and 6 percent in the second year of the biennium. Raises the base reimbursement rate for child care centers in the Pre-K program, allowing for a 2 percent raise in each year of the biennium.
Sets out parameters for children/families that qualify for child care subsidy, based on annual maximum gross income, children 0-5, and those with special needs, living in families earning below 200 percent federal poverty level (FPL) qualify, children 6-12 in families earning less than 133 percent FPL qualify. Sets out parameters for children/families that qualify for child care subsidy, based on annual maximum gross income, children 0-5, and those with special needs, living in families earning below 200 percent federal poverty level (FPL) qualify, children 6-12 in families earning less than 133 percent FPL qualify.
Sets cost-sharing standards for families qualifying for the childcare subsidy, requiring that care received at blended rate, that the copayment will equal 83 percent of the full-time copayment, part-time care copay set at 75 percent of the full-time rate. Sets cost-sharing standards for families qualifying for the childcare subsidy, requiring that care received at blended rate, that the copayment will equal 83 percent of the full-time copayment, part-time care copay set at 75 percent of the full-time rate.
Allows counties with small programs to apply the statewide rate if the county rate is inhibiting the county’s ability to purchase child care for eligible children. Allows counties with small programs to apply the statewide rate if the county rate is inhibiting the county’s ability to purchase child care for eligible children.
Total Subsidized Child Care appropriation equal $49.2M; federal funds make up the bulk of the $406M in total child care subsidy, an increase of about $6.5M overall. $13.9M for subsidy comes from additional Child Care and Development Fund Block Grant; $8.4M in TANF block grant funds go to subsidy, while overall TANF block grant is reduced by $14.8M; replaces $7M in general fund appropriations with TANF funding, reduces staff by three people. Total Subsidized Child Care appropriation equal $50.9M; federal funds make up the bulk of the $402M in total child care subsidy, an increase of about $3.5M overall. $10.25M for subsidy comes from additional Child Care and Development Fund Block Grant; $8.4M in TANF block grant funds go to subsidy, while overall TANF block grant is reduced by $14.8M; replaces $5.4M in general fund appropriations with TANF funding, staffing unchanged.
Moves $358,254 in annual funding from the Child Care and Development Fund Block Grant to administer the program. Moves $358,254 in annual funding from the Child Care and Development Fund Block Grant to administration, including funding for a lease agreement due to the move of the Division off of Dix campus.
Overall, cuts DCDEE funding by $1.8M of general fund dollars. Overall, cuts DCDEE funding by $5.7M of general fund dollars.
Orders DHHS to allocate Child Care Subsidy funds using money from local NC Partnership for Children organizations as the base. Sets the base amount for each county’s child care subsidy allocation. Modifications this year include language that allows the Division to withhold up to 2 percent of available funds as a hedge against fraud/program termination because of fraud and having to pay back federal funds as a result. Requires DHHS to report to JLOC on HHS on the funds withheld each year of the biennium 30 days after the withheld funds are distributed. Adds language allowing DHHS to set aside 4 percent of the subsidy funds for “vulnerable populations.” Allows for re-allocation of unused funds and sets out spending guidelines. Also sets out guidelines for market rate increases. Orders DHHS to allocate Child Care Subsidy funds using money from local NC Partnership for Children organizations as the base. Sets the base amount for each county’s child care subsidy allocation. Modifications this year include language that allows the Division to withhold up to 2 percent of available funds as a hedge against fraud/program termination because of fraud and having to pay back federal funds as a result. Requires DHHS to report to JLOC on HHS on the funds withheld each year of the biennium 30 days after the withheld funds are distributed. Adds language allowing DHHS to set aside 4 percent of the subsidy funds for “vulnerable populations.” Allows for re-allocation of unused funds and sets out spending guidelines. Also sets out guidelines for market rate increases.
Sets out policies for Smart Start initiatives to improve child care quality for children under 5 years old. Caps administrative costs for local Partnerships for Children to 8 percent, requires the NC Partnership for Children to use a single statewide contract management system and sets a maximum for the amount of state dollars to be used for salaries. Sets out policies for Smart Start initiatives to improve child care quality for children under 5 years old. Caps administrative costs for local Partnerships for Children to 8 percent, requires the NC Partnership for Children to use a single statewide contract management system and sets a maximum for the amount of state dollars to be used for salaries.
Total Smart Start outlay for FY 19-20: $152M, for FY 20-21: $149M Total Smart Start outlay for FY 19-20: $149M, for FY 20-21: $149M
In FY 19-20, appropriates $3.5M in one-time funds for Smart Start related activities; $750,000 in additional funding for family support activities; and $750,000 in additional funding for health related activities. In FY 19-20, appropriates $1.4M in one-time funds for Smart Start related activities; $300,000 in additional funding for family support activities; and $300,000 in additional funding for health related activities. Allocates $392,654 in receipts to Smart Start subsidy (no General Fund outlay)
Sets fundraising match requirements for the statewide Partnership for Children and the local affiliates, ordering that they shall raise a matching amount of 100 percent of the budget for the program each of the two-years of the biennium, with cash contributions making up 13 percent of the match, in-kind services no more than 6 percent of the match, for total match of 19 percent. Sets out criteria for what constitutes and how to account for in-kind donations. Unchanged from 2017 budget. Sets fundraising match requirements for the statewide Partnership for Children and the local affiliates, ordering that they shall raise a matching amount of 100 percent of the budget for the program each of the two-years of the biennium, with cash contributions making up 13 percent of the match, in-kind services no more than 6 percent of the match, for total match of 19 percent. Sets out criteria for what constitutes and how to account for in-kind donations. Unchanged from 2017 budget.
Mandates that failure to raise the required amount (above) will result in a dollar-for-dollar reduction in the program for the subsequent year. Also sets out bidding processes for contracted services. Unchanged from 2017 budget. Mandates that failure to raise the required amount (above) will result in a dollar-for-dollar reduction in the program for the subsequent year. Also sets out bidding processes for contracted services. Unchanged from 2017 budget.
Orders allocations in smaller counties to not drop below 2012-13 levels, sets forth instructions for evaluation system, and sets expenditure restrictions. Unchanged from 2017 budget. Orders allocations in smaller counties to not drop below 2012-13 levels, sets forth instructions for evaluation system, and sets expenditure restrictions. Unchanged from 2017 budget.
Prohibits use of state dollars for advertising/promotional activities, although private monies may be spent on these activities. Sets timeline for annual reports to the legislature. Prohibits use of state dollars for advertising/promotional activities, although private monies may be spent on these activities. Sets timeline for annual reports to the legislature.
Orders that funds from the NC Partnership for Children funding be set aside to allow for increased access to Dolly Parton’s Imagination Library. Orders that funds from the NC Partnership for Children funding be set aside to allow for increased access to Dolly Parton’s Imagination Library.
Allows NC Partnership for Children to use up to 1 percent of statewide funds for admin, up to 1 percent for program evaluation. Allows NC Partnership for Children to use up to 1 percent of statewide funds for admin, up to 1 percent for program evaluation.
Provides additional one-time funding each year of $1M for Reach Out and Read program that enables pediatricians to “prescribe” reading to young patients. No mention.

Division of Health Benefits

Division of Health Benefits
For FY 2019-20, budgets $4.313 Billion for Medicaid payments, Medicaid rebase set at $318.8 million, requiring General Fund outlay of $30.2M For FY 2019-20, budgets $4.304 Billion for Medicaid payments, Medicaid rebase set at $341.1 million, requiring General Fund outlay of $37.3M
Cuts Medicaid management by $15M in FY 19-20, which results in total loss of management funds of $45M when the federal match is taken into account, cuts $7.5M in 20-21, which results in total loss of management funds of $20.7M Cuts Medicaid management by $15M in FY 19-20, which results in total loss of management funds of $45M when the federal match is taken into account, cuts $7.5M in 20-21, which results in total loss of management funds of $20.7M
Transfers total of $232.9M from the Medicaid Transformation fund to DHB to cover costs of transformation listed as: beneficiary experience/ enrollment broker, NC FAST upgrades, provider assistance, data management, program integrity, technical and operational integration, additional positions. Transfers total of $226M from the Medicaid Transformation fund to DHB to cover costs of transformation listed as: program design, enrollment broker, NC FAST upgrades, data management, program integrity, technical and operational integration and year one administrative costs. Appropriates $28.6M in general fund dollars for recurring projects, and cuts an additional $30.6M in administrative costs across DHHS. Transfers $2M more than needed for from the Transformation fund.
No detail on the use of Medicaid Transformation Fund given. Notes transfer of $210M in FY 19-20 and $22.3M in FY 20-21 from the Medicaid Transformation fund to the General Fund to cover the costs of any additional claims that need to be paid under the old fee-for-service system and cover other transformation costs. Then, in FY 19-20, takes $150M of that money to pay outstanding claims and $49M for administration, leaving $10.7M for General Fund uses. All told, $532M comes out of the transformation fund in FY 19-20. In FY 20-21, budget takes out an additional $22.3M to cover these costs (by this time, the system should have converted to managed care).
Outlines Medicaid eligibility, which is adjusted to meet federal poverty level guidelines and stipulates the delivery of the annual Medicaid report. Outlines the different eligibilty categories for receiving Medicaid, includes category for “Individuals who meet eligibility criteria under a Medicaid waiver approved by the Centers for Medicare and Medicaid Services” Outlines Medicaid eligibility, which is adjusted to meet federal poverty level guidelines and stipulates the delivery of the annual Medicaid report. Outlines the different eligibilty categories for receiving Medicaid, includes category for “Individuals who meet eligibility criteria under a Medicaid waiver approved by the Centers for Medicare and Medicaid Services”
Sets date for annual Medicaid report at Dec 31 of each year. Sets date for annual Medicaid report at Dec 31 of each year.
Orders DHHS to issue Medicaid identification cards annually and as needed, gives DHHS the ability to set rules around ID cards. Orders a report on these rules for July 2020. Orders DHHS to issue Medicaid identification cards annually and as needed, gives DHHS the ability to set rules around ID cards. Orders a report on these rules for July 2020.
Appropriates $1 million in each FY to the Office of Administrative Hearings for Medicaid appeals. This also allows for drawdown of federal funds for appeals. Appropriates $1 million in each FY to the Office of Administrative Hearings for Medicaid appeals. This also allows for drawdown of federal funds for appeals.
Empowers the Division of Health Benefits to contract for services, equipment, supplies, and volume purchases as needed to hold down costs. Empowers the Division of Health Benefits to contract for services, equipment, supplies, and volume purchases as needed to hold down costs.
Orders the DHB to ensure LME/MCOs to use out-of-network agreements in lieu of a “comprehensive provider contract” as needed, with common elements. This allows for some individual treatment options as needed. Orders the DHB to ensure LME/MCOs to use out-of-network agreements in lieu of a “comprehensive provider contract” as needed, with common elements. This allows for some individual treatment options as needed.
Orders the state’s seven LME/MCOs to transfer $18 million in one-time administrative funds in each FY of the biennium to the Div of Health Benefits. Sets out how much is owed by each LME/ MCO. Annual boilerplate language. Orders the state’s seven LME/MCOs to transfer $18 million in one-time administrative funds in each FY of the biennium to the Div of Health Benefits. Sets out how much is owed by each LME/ MCO. Annual boilerplate language.
Increases copays for Medicaid services to $4, except for services provided through Medicaid waivers, reflected in a cut of $3.5M to the program (because more will be paid by receipts). Increases copays for Medicaid services to $4, except for services provided through Medicaid waivers, reflected in a cut of $3.5M to the program (because more will be paid by receipts).
Increases slots for Innovations Waivers for people with I/DD by 150. Slots distributed to the LME/MCOs on a per capita basis, each slot to be made available in March 2020. Slots to be awarded on a first-come, first-served basis. Total of $4.3M in spending over the biennium. Increases slots for Innovations waivers for people with I/DD by 1000. Total cost of $32.5M over the biennium.
Appropriates $11.6M in FY 19-20 and $11.4 in FY 20-21 to “in lieu of” services for people with I/DD. These are services that could be provided in a group home setting but might be available in the community for the same cost or less.
Orders DHB to convene a stakeholders workgroup to address the waiting list for Innovations waiver slots. Orders the creation of a ten-year plan to address the backlog, which stands at approx 12,000. Also, appropriates $250,000 FY 19-20 to DHB to develop a plan for providing additional funding to address the waiting list backlog. Study to be submitted Oct, 2020. Orders DHB to convene a stakeholders workgroup to address the waiting list for Innovations waiver slots. Orders the creation of a ten-year plan to address the backlog, which stands at approx 12,000. Also, DHB to develop a plan for providing additional funding to address the waiting list backlog. Study to be submitted Dec. 2020
Appropriates $1.4M in FY 19-20 and $1.5M in 20-21 for an electronic visit verification system for Medicaid beneficiaries receiving personal care services or other home- or community-based care. Appropriates $1.4M in FY 19-20 and $1.5M in 20-21 for an electronic visit verification system for Medicaid beneficiaries receiving personal care services or other home- or community-based care.
Appropriates $5.5 million in FY 2019-20 and $11 million in FY 2020-21 to increase the capitation rate paid to LME/MCOs for people living in group homes serving adults with I/DD and mental health issues. Funds to be used to increase wages for personnel working in these facilities to bring salaries in line what’s paid in state-funded facilities serving similar populations. Salary increases to be achieved by January 2020. No mention.
Appropriates $45.2M/annum in General Fund spending on NC Health Choice (the state’s Children’s Health Insurance Program) Appropriates $45.2M/annum in General Fund spending on NC Health Choice (the state’s Children’s Health Insurance Program)
Appropriates $250,000 to conduct an actuarial analysis and wage and hour study of the Innovations Waiver in order to determine the appropriate adjustment to per-slot waiver costs. To be examined: average costs of services and wages paid, administrative costs needed, number of FTEs needed to support program/services, cost of increasing wages to $15/hour, cost to increase the number of waiver slots. Sets out methodology for determining “appropriate wages to be paid.” Study to be submitted in early 2020. Orders a study via a workgroup on reimbursement options for paying adult care homes to house people with intellectual, developmental and mental health disabilities. The work group is to include representatives from the adult care home industry “and other relevant stakeholders”. Part of what the group should look at are: alternative payment models, that could include filing an 1115 waiver to CMS, looking at best practices for long-term care and better payment methodologies. Study to be delivered after the 2020 election.
Predicts $424M in drug rebates in each FY Predicts $424M in drug rebates in each FY
Tightens eligibility requirements for passing along disabled status for a child turning 18 to: 1) adult entiteld to RSDI benefits as a disabled adult child and would be eligible for SSI if the RSDI were disregarded; person is blind or was disabled before the age of 22; adult receiving state/ county Special Assistance is currently living in an adult care home. Tightens eligibility requirements for passing along disabled status for a child turning 18 to: 1) adult entiteld to RSDI benefits as a disabled adult child and would be eligible for SSI if the RSDI were disregarded; person is blind or was disabled before the age of 22; adult receiving state/ county Special Assistance is currently living in an adult care home.
Increases the reimbursement for primary care providers: primary care physicians, OB/GYNs, nurse practitioners, physician assistants. Increases the reimbursement for primary care providers: primary care physicians, OB/GYNs, nurse practitioners, physician assistants.
Limits the length of time any financial changes made to Medicaid in this budget to end June 2021. Limits the length of time any financial changes made to Medicaid in this budget to end June 2021.
Orders that any Medicaid shortfalls be covered by the Medicaid contingency fund, sets out stipulations on use of these funds (which includes generating an analysis of the shortfall). No mention.
Appropriates $40.2M annually from the Medicaid Transformation Fund to cover need in the Division of Health Benefits as Medicaid transforms into managed care system. Allows for the transfer of funds from DHB to pay claims as they run out in the changeover from fee for service Medicaid to managed care Medicaid. According to Sen. Ralph Hise, this amounts to about a $150 million worth of claims.
Funding for NC FAST ongoing operations: $5.75M in FY 2019-20 and $7.9M in FY 2020-21. Total IT budget: $40.9M in FY 19-20, $43.2M in FY 20-21 Funding for NC FAST ongoing operations: $6.8M in FY 2019-20 and $11.04M in FY 2020-21 Total IT budget: $59M in FY 19-20, $54.3M in FY 20-21
Creates a special fund to pay for upgrades to NC FAST, appropriates $42.9M over two years to pay for bringing the system into compliance with federal laws, creating 24/7 access, etc. Creates a special fund to pay for upgrades to NC FAST, appropriates $59M over two years to pay for bringing the system into compliance with federal laws, creating 24/7 access, etc. Specifically appropriates $7.1M in one-time funding for FY 19-20 and $4M in one-time funding in FY 20-21 to update NC FAST to comply with Rylan’s Law, the Federal Family First Prevention Services Act and other new federal requirements. Adds $2.4M / FY to create NC FAST infrastructure to allow for 24/7 access to data. And allocates $1.6M in FY 20-21 to create document management services that allow county DSSs and federal staff the ability to share data.
Takes $7.46M in funding from DHHS’ Central Management to support hardware, software, infrastructure purchases, etc.
Once Medicaid is transformed into a managed care system, $55.9 million to fund DHB in the FY 19-20 and $51.1 million in FY 20-21 to cover staffing, IT, contract management, ombudsmen programs, provider credentialing and other “qualifying needs” that are required for overseeing the managed care entities that will deliver Medicaid services. DHB needs to request funding for the FY 19-20 as needed, and only released until the OSBM verifies certain financial requirements. Federal funds received to compensate for state spending to go into the Medicaid Transformation Fund. Once Medicaid is transformed into a managed care system, $49 million to fund DHB in the 2019-20 FY and $10.9 million in FY 20-21 to cover staffing, IT, contract management and other needs that are required for overseeing the managed care entities that will deliver Medicaid services, with funds in 2020-21 being one-time dollars. Limits qualifying needs to program design, enrolllment broker services, NCFAST upgrades, data mnagement, program integrity, technical and operations integration, and FY 19-20 administrative expenses related to transition.
No mention. Postpones the deployment of the aging and the child welfare components of NC FAST the state’s social services master information program. Keeps counties currently in the pilot phase of using the components in the pilot. The rest of the state’s counties can implement the intake and assessment functionality of NC FAST if they wish. Orders DHHS to issue an RFP for a contract to develop a child welfare case-management component for NC FAST but restricts the department from issuing a contract until the NCGA reviews. Orders the legislative Program Evaluation Division to study the case-management functionality of the child-welfare component of the system and report in May 2020.
Orders DHHS to alter the Customer Service hotline to be receptive to calls and questions created by the rollout of Medicaid Transformation. No mention.
No mention. Cuts $30.68 million from DHHS budget in FY 19-20 and $42.7 million in FY 20-21, gives the Secretary discretion to make cuts within the department, Orders that the Secretary not reduce direct services, not affect the 2012 DOJ settlement on mental health housing, and orders an annual report to the legislature on how these cuts were made.
Gives DHHS the ablity to contract with Indian health care providers to manage provision of Medicaid services in Native American populations, including for creation of behavioral health plans, provision of home and community-based services, etc. Allows for members of official Indian tribes to choose to have Medicaid provided by a commercial plan rather than an Indian health care provider. Requires $9M in FY 19-20 and $3M in FY 20-21, paid for by federal receipts, monies from the Medicaid Transformation fund. Gives DHHS the ablity to contract with Indian health care providers to manage provision of Medicaid services in Native American populations, including for creation of behavioral health plans, provision of home and community-based services, etc. Allows for members of official Indian tribes to choose to have Medicaid provided by a commercial plan rather than an Indian health care provider. Requires $9M in FY 19-20 and $3M in FY 20-21, paid for by federal receipts.
Repeals an earlier order to eliminate Graduate Medical Education payments that come with Medicaid and to align with newer requirements that come with Medicaid Transformation Repeals an earlier order to eliminate Graduate Medical Education payments that come with Medicaid and to align with newer requirements that come with Medicaid Transformation
Currently, there’s a supplemental program that tries to compensate hospitals for what they lose by providing Medicaid services (Medicaid tends to pay at or below hospital costs). This supplemental payment program is currently funded by a tax on hospitals, where the amount collected by the state from hospitals is calculated to make this payment The state currently makes this assessment (tax), of which the state keeps about $110 million, which goes into the General Fund, and uses the remainder to pay hospitals for the losses they take on Medicaid. Language in the budget changes this because with managed care, DHHS no longer does direct payments to hospitals, and there’s no legal authority to collect this assessment from hospitals. so the NCGA is creating this calculated, direct tax on hospitals, which is a percentage of total hospital costs. So, larger hospitals will pay more tax than smaller hospitals. This budget sets the base rate at 2.26 percent and the supplemental rate at 1.3 percent. Currently, there’s a supplemental program that tries to compensate hospitals for what they lose by providing Medicaid services (Medicaid tends to pay at or below hospital costs). This supplemental payment program is currently funded by a tax on hospitals, where the amount collected by the state from hospitals is calculated to make this payment The state currently makes this assessment (tax), of which the state keeps about $110 million, which goes into the General Fund, and uses the remainder to pay hospitals for the losses they take on Medicaid. Language in the budget changes this because with managed care, DHHS no longer does direct payments to hospitals, and there’s no legal authority to collect this assessment from hospitals. so the NCGA is creating this calculated, direct tax on hospitals, which is a percentage of total hospital costs. So, larger hospitals will pay more tax than smaller hospitals. This budget sets the base rate at 1.51 percent and the supplemental rate at 2.31 percent.
In addition, the budget language exempts critical access hospitals, psychiatric and rehabilitation hospitals, long-term care hospitals, state-owned/ operated hospitals (such as Central Regional), UNC Chapel Hill and ECU/ Vidant hospitals. In addition, public hospitals, such as Atrium and other “public” hospitals are exempted from the supplemental assessments. In addition, the budget language exempts critical access hospitals, psychiatric and rehabilitation hospitals, long-term care hospitals, state-owned/ operated hospitals (such as Central Regional), UNC Chapel Hill and ECU/ Vidant hospitals. In addition, public hospitals, such as Atrium and other “public” hospitals are exempted from the supplemental assessments.
No mention. Limits authority for these transfers to expire June 30, 2020.
No mention. Senate budget creates a fund to be created if the state collects too much tax, creates a fund be held in order to reduce either of the base or supplemental tax rates in future years. This fund capped at $30 million.
Stipulates that hospitals cannot add the costs of this assessment to patient bills in any way. Stipulates that hospitals cannot add the costs of this assessment to patient bills in any way.
No mention. Creates a tax levy onto the prepaid health plans what will manage Medicaid under the transformed system. Creates a tax based on the gross premiums collected by the PHPs, at the rate of 1.9 percent, with the revenue to go into the General Fund.
No mention. Changes the Medicaid state plan to eliminate the enhanced payment for services to ECU/ Vidant Hospital in Greenville, reimbursing that hospital at the same rate as private hospitals in the state. Leaders at that institution estimate this results in about a $35 million cut to reimbursement.

Division of Health Service Regulation

Division of Health Service Regulation
Allocates $350,000 / fiscal year to continue a community paramedic pilot that’s taking place in New Hanover, McDowell and Wake Counties, keeping the pilot intact and continuing. Orders DHHS to report by November 2021 on the costs, savings and a timeline for expanding the pilot to other counties. Allocates $140,000 over the biennium to continue a community paramedic pilot that’s currently taking place in New Hanover, McDowell and Wake Counties but only continuing it in McDowell County. Orders DHHS to report by December 2021 on the costs, savings and a timeline for expanding the pilot to other counties.
Extends a multi-year moratorium on the creation of special care units used for caring for people with dementia. Orders DHHS to submit a report on the number of units in the state, their capacity, anticipated growth in people who will need services and how many applications have been received to create these units and how many have been denied. Extends a multi-year moratorium on the creation of special care units used for caring for people with dementia. Orders DHHS to submit a report on the number of units in the state, their capacity, anticipated growth in people who will need services and how many applications have been received to create these units and how many have been denied.
no mention. Creates a two year moratorium on home care agency licenses for in-home aide services. However, this does not apply to companion, respite or sitter services. Requires a report to be delivered in March 2021 on the number of agencies, how many applications are on hold, the capacity of the agencies and the anticipated growth of the people who would require these services.
no mention. Changes the laws around certificate of need, the regimen of regulations on hospitals. Removes dialysis centers, psychiatric facilities, substance abuse treatment centers, ICFMRs, and diagnostic centers from the regulations on number of providers. Also allows for freestanding ambulatory surgical centers and GI diagnostic (colonoscopy) centers. Also limits the state’s ability to limit the number of operating rooms or GI colonoscopy centers, all as of October 2019. Sets out the data required by freestanding ambulatory surgical centers and sets out charity care requirements.
no mention. Creates a requirement that continuing care retirement communities wishing to provide home or skilled care for people who do not live in the CCRC be certified to become a home health agency.
no mention. Sets out a 2 year time limit for facilities receiving CON designations / permissions to complete building, and creates an automatic withdrawal of the CON if the facility is inoperable after a year. Expedites the timeline for challenges to certificates, limits the length of time those challenges can stretch out. Creates a “loser pays” regimen.
Eliminates three positions that are currently unfilled (engineer, architect and program analyst), cutting the cost of those salaries by $256,721 No mention.
Mental Health/ Developmental Disabilities/ Substance Abuse Services Mental Health/ Developmental Disabilities/ Substance Abuse Services
Reduces state funding to LME/MCOs by $36.4 million / FY, with distribution of effect on individual LMEs outlined in the budget language. Changes the distribution schedule to LME/MCOs to even out monthly cash flow requirements. Requires LME/MCOs to retain spending at 2014-15 levels. Reduces state funding to LME/MCOs by $36.4 million/FY, with distribution of effect on individual LMEs outlined in the budget language. Calls for additional $15M recurring cut to LME/MCOs. Changes the distribution schedule to LME/MCOs to even out monthly cash flow requirements. Requires LME/MCOs to retain spending at 2014-15 levels.
No mention. Orders DHHS to create requirements fo LME/MCOs’ “maintenance of effort.” Limits the organizations’ expenditures to state dollars. This maintenance of effort requirement does not extend to individual beneficiaries, but beneficiaries having their benefits cut can’t argue in court that it was because of state budget cuts.
Makes a provision that allows for reimbursement of $30 million of that single stream funding if there is a Medicaid surplus at the end of the year, to offset these reductions. No mention.
Trims the budget for the Riddle Center by $15,151. Trims the budget for the Riddle Center by $15,151.
Moves $661,042 in funding from the federal Mental Health Block Grant to provide for more mental health services to children. No net General Fund appropriation. Moves $661,042 in funding from the federal Mental Health Block Grant to provide for more mental health services to children. No net General Fund appropriation.
Appropriates $40.6 million in annual funds for each FY to cover the costs of “three-way” inpatient psychiatric beds in local hospitals closer to the homes of patients than state institutions. Stipulates that the funds not be used to supplant other funds which have been cut. Appropriates $40.6 million in annual funds for each FY to cover the costs of “three-way” inpatient psychiatric beds in local hospitals closer to the homes of patients than state institutions. Stipulates that the funds not be used to supplant other funds which have been cut.
Orders DHHS to oversee that those inpatient three-way bed days are used for people who are otherwise indigent or unable to pay for psychiatric care and distributed across the LME/MCO catchment areas and according to greatest need. Also orders DHHS to insure that contracts for these bed days are distributed equitably across the state. Orders DHHS to oversee that those inpatient three-way bed days are used for people who are otherwise indigent or unable to pay for psychiatric care and distributed across the LME/MCO catchment areas and according to greatest need. Also orders DHHS to insure that contracts for these bed days are distributed equitably across the state.
Funds for three-way psychiatric beds not used are to be held in statewide reserve by DHHS, and LME/MCOs to make claims for payment for care to DHHS. And empowers DHHS to transfer management of beds from one LME/MCO to another if the department determines the utilization is not meeting need. Requires LME/MCOs to report utilization. Funds for three-way psychiatric beds not used are to be held in statewide reserve by DHHS, and LME/MCOs to make claims for payment for care to DHHS. And empowers DHHS to transfer management of beds from one LME/MCO to another if the department determines the utilization is not meeting need. Requires LME/MCOs to report utilization.
Orders DHHS to report to legislative oversight committee annually about how bed days are purchased and distributed, note the number of medically indigent people served, amount used for facility-based crisis services, how much used for detox and other programs designed to reduce state psychiatric hospital use. Orders DHHS to report to legislative oversight committee annually about how bed days are purchased and distributed, note the number of medically indigent people served, amount used for facility-based crisis services, how much used for detox and other programs designed to reduce state psychiatric hospital use.
Allocates $2.3 million / FY in recurring funds for services for Traumatic Brain Injury patients. Stipulates which organizations can be funded to provide services. Allocates $2.3 million / FY in recurring funds for services for Traumatic Brain Injury patients. Stipulates which organizations can be funded to provide services.
No mention. Continues an adult/ child traumatic brain injury pilot program created in the 2017 budget which was intended to increase compliance with new evidence-based treatment guidelines to treat and maintain victims, while reducing long-term costs. DHHS was to choose up to three sites at trauma hospitals, each initially received funding. DHHS was ordered to use recommendations created by the American Association of Neurological Surgeons in the pilots.This budget appropriates $300,000 in one-time funding for 2019-20 FY, orders a report from DHHS on the program.
Adds $344,903 from the federal Mental Health Block Grant into a state program to provide services for young people experiencing their first psychotic episode. No net expenditure from the General Fund. Adds $344,903 from the federal Mental Health Block Grant into a state program to provide services for young people experiencing their first psychotic episode. No net expenditure from the General Fund.
All told, appropriates $44.2M in adult substance abuse services funding, paid for by receipts (federal funding). All told, appropriates $44.2M in adult substance abuse services funding, paid for by receipts (federal funding).
Requires any funds remaining in the Dorothea Dix Hospital Property Fund to remain in that fund. Requires any funds remaining in the Dorothea Dix Hospital Property Fund to remain in that fund.
No mention. Earmarks the use of $500,000 from the Dorothea Dix Hospital Property Fund to pay for completion of the Residential Treatment Center for Women operated by The Samaritan Colony in Richmond County. Facility located in a districts represented by Rep. Scott Brewer and Sen. Tom McInnis.
No mention. Earmarks the use of $600,000 in one-time funding from the Dorothea Dix Hospital Property Fund to go to the Bridge to Recovery in Monroe, NC to provide substance abuse treatment services. Faciity located in districts represented by Rep. Dean Arp and Sen. Todd Johnson.
Appropriates $8.8 million in FY 20-21 to create up to 60 positions at the new Broughton Hospital and to cover costs related to plan for and to move patients from the old hospital to the new one, also for operational costs of running new beds. Appropriates $4.9 million in FY 2020-21 to support staffing, support, utilities, maintenance, etc to open new Psychiatric Intensive Care Unit beds at the new Broughton Hospital. No new FTEs.
Creates $8 million in supplemental funding in FY 2019-20 to enhance payments to group homes for people with mental illness or developmental disabilities who were eligible for Medicaid personal care service reimbursement prior to January 2013 who would have been determined to be ineligible after that date and who have continued to reside in group homes since that time. Sets a per resident limit of $464.30 for the payment and sets stipulations on how the money is to be used by group homes. Ends the funding at the end of the 2019-2020 FY. Requires group homes to report on funding. Forbids any of the funding to go to DHHS. Creates $1.8 million in supplemental, one-time funding in each fiscal year to enhance payments to group homes for people with mental illness or developmental disabilities who were eligible for Medicaid personal care service reimbursement prior to January 2013 who would have been determined to be ineligible after that date and who have continued to reside in group homes since that time. Sets a per resident limit of $464.30 for the payment and sets stipulations on how the money is to be used by group homes. Ends the funding at the end of the 2021 FY. Requires group homes to report on funding. Forbids any of the funding to go to DHHS.
Does not obligate the General Assembly to continue this funding into the future, limits the support given to group homes to this total appropriation, and transfers any leftover funds to the “Group Home Stabilization and Transition Initiative” that’s created in the budget. Does not obligate the General Assembly to continue this funding into the future, limits the support given to group homes to this total appropriation, and terminates this funding at the end of the 2020-21 FY.
Creates a Group Home Stabilization and Transition Initiative with $23 million of one-time funds for FY 20-21 to incentivize LME/MCOs to create new services to suport the needs of people currently living in group homes. Orders the Division of Mental Health to create new rate models and methodologies to replace the current way of paying for group home residents. No mention.
Orders DHHS to develop “a more appropriate and sustainable service model” for paying for residents of group homes for people with mental health/ I/DD issues. Rates should be comparable to those currently used through the Innovations Waiver, also stipulates that the new rates should include increases for support personnel working in group homes. No mention.
Orders DHHS plus stakeholders to create new service definitions for residential support services to address the needs of people living in community-based group homes, those new definitions should include new habilitation and rehab support services and include transition plans for homes and clients to “more sustainable and appropriate Medicaid services.” Requires study/ report/ plan to be delivered to legislature by November 2020 for implementation in January 2021. No mention.
Orders a report to be made annually by DHHS each September on the use of funds for inpatient alcohol and substance use disorder treatment at ADATCs icluding info on: number of beds and bed-days, amount of receipts and where they came from, operating costs, personnel costs, profit / loss. Orders a report to be made annually by DHHS each September on the use of funds for inpatient alcohol and substance use disorder treatment at ADATCs including info on: number of beds and bed-days, amount of receipts and where they came from, operating costs, personnel costs, profit / loss.
Allocates $100,000 to pay for naloxone, the opioid overdose reversal medication, with $75,000 to go to the NC Harm Reduction Coalition and the rest to law enforcement agencies. Allocates $100,000 to pay for naloxone, the opioid overdose reversal medication, with $75,000 to go to the NC Harm Reduction Coalition and the rest to law enforcement agencies.
Stipulates that $1.4 million in funding that went to Vaya Health, the westernmost LME/MCO in the state that was appropriated in the 2018 budget for construction of a facility-based crisis center in Wilkes County, now be considered a grain-in-aid. Orders any leftover money to be used by the end of 2019. Stipulates that $1.4 million in funding that went to Vaya Health, the westernmost LME/MCO in the state that was appropriated in the 2018 budget for construction of a facility-based crisis center in Wilkes County, now be considered a grain-in-aid. Orders any leftover money to be used by the end of 2019.
Of the funding appropriated to the Division of Mental Health, orders that $125,000 in annual funds be used as a grant to the NC Association of People Supporting Employment First to develop and implement training programs for people with I/DD and mental issues to get integrated, paid and “competitive” employment and orders DHHS to make this training available statewide. Targets the funds to those people who are or at risk of entry into an adult care home. Of the funding appropriated to the Division of Mental Health, orders that $125,000 in annual funds be used as a grant to the NC Association of People Supporting Employment First to develop and implement training programs for people with I/DD and mental issues to get integrated, paid and “competitive” employment and orders DHHS to make this training available statewide. Targets the funds to those people who are or at risk of entry into an adult care home.
Of the funding appropriated to the Division of Mental Health, orders $300,000 in annual funds to the Alcohol Law Enforcement Branch to do compliance checks to enforce the smoking age for youth. Of the funding appropriated to the Division of Mental Health, orders $300,000 in annual funds to the Alcohol Law Enforcement Branch to do compliance checks to enforce the smoking age for youth.
Of the funding appropriated to the Division of Mental Health, orders that $500,000 from the Substance Abuse Prevention and Treatment Block Grants be used as continuing funds for a medication-assisted treatment pilot program that uses the injectable opioid-antagonist drug Vivitrol which was created in the 2016 budget. Changes the date for an evaluation to be presented to the NCGA to March 2021; evaluation of the pilot should include how many people were treated and who remained abstinent after treatment and the cost-benefit analysis.
Allocates $180,000 in one-time funds for Partners Behavioral Health Management to perform a feasibility study on creating a crisis center in Burke County. Stipulates any study should include a program description, market/ demand analysis, current capacity, site proposals, estimates of start-up costs, annual operating costs and anticipated sources of revenue, along with an implementation time line. No mention.
Orders DHHS to create a work group to look at administration of services for people with mental health, intellectual and developmental disabilities and substance use disorders. Calls for review of all the requirements placed on providers of services for these populations, including issues such as documentation, facility licensure, credentialing and accreditation, contracts and claims processing, among others. Also requested, a review of which agency created each requirement, state and federal laws, etc, and make recommendations as to whether each requirement should remain, be eliminated or redesigned. One factor to consider: the ability to incorporate any of these requirements into standard electronic health records. Report due March 2020. No mention.
Appropriates $500,000 each FY to fund two Peer Wellness Center pilot programs, one located in a rural community, one in an urban one. The centers should: offer services to enhance recovery, be owned, operated and staffed by peer facilitators who are certified Peer Support Specialists and take referrals from advocates, mental health service providers, hospitals, etc. Sets up a system for competitive grant proposals for the Peer Wellness Center pilot programs, which are intended to reduce utilization of hospitalization and crisis services. Pilot proposals should include information on expected outcomes and how those outcomes will be measured and evaluated. No mention.
Within six months of completion of these pilot periods, the programs should report data to the Division of Mental Health with recommendations about how well they functioned and whether to expand the pilot into a statewide program. No mention.
Appropriates $5M / FY for increased funding for substance abuse treatment programs, targeted at opioid use/ abuse. Appropriates $5M / FY for increased funding for substance abuse treatment programs, targeted at opioid use/ abuse.
Provides $1M to replace medication carts across the state’s eight state-operated facilities. Provides $1M to replace medication carts across the state’s eight state-operated facilities.
Earmarks $100,000 in FY 20-21 to the Christ Centered Recovery Program based in Morganton. Located in district represented by Rep. Hugh Blackwell, Sen. Warren Daniel
Earmarks $500,000/ FY to Holy Angels, a facility in Gaston County caring for people with severe intellectual and developmental disabilities. District represented by Rep. John Torbett, Sen Kathy Harrington
Earmarks $250,000 to First Step Farm of Western NC, in Candler, a substance abuse treatment program. District represented by Rep. Bryan Turner and Sen. Chuck Edwards.
Moves $5M from the federal Mental Health Block Grant to provide funding for adult and child mental health services. Moves $1.95M from the federal Mental Health Block Grant to provide funding for adult and child mental health services.
Moves funding from the federal Substance Abuse Prevention and Treatment Block Grant to supplement adult and child substance abuse treatment by $1.8 million recurring.
Because of reductions in federal Substance Abuse Prevention and Treatment block grant monies, reduces funding for treatment services and recovery support by $578,538 in FY 19-20 and by $1,531,279 in FY 20-21 recurring. Moves funding from the federal Substance Abuse Prevention and Treatment block grant to supplement adult and child substance abuse treatment by $578,538 recurring and $241,488 recurring for HIV testing for people in treatment. Amounts reduced because of federal cuts to the SAPTBG.
Because of reductions in federal Substance Abuse Prevention and Treatment block grant monies, reduces funding for HIV testing for people in treatment by $241,488 recurring.

Division of Public Health

Division of Public Health
Because of a reduction in federal Preventive Health Services Block Grant funding, orders $301,809 to be cut from oral health prevention services which were paid for with these monies. In addition, cuts $8,171 in funding for HIV/STD prevention and planning funding and $514,977 in funds for physical activity and prevention funding, which were also paid for by the PHSBG. Because of a reduction in federal Preventive Health Services Block Grant funding, orders $301,809 to be cut from oral health prevention services which were paid for with these monies. In addition, cuts $8,171 in funding for HIV/ STD prevention and planning funding and $514,977 in funds for physical activity and prevention funding, which were also paid for by the PHSBG.
Trims budget for the State Center for Health Statistics by $24,786 because of cut in Preventive Health Services Block Grant. No reduction in personnel. Trims budget for the State Center for Health Statistics by $24,786 because of cut in Preventive Health Services Block Grant. No reduction in personnel.
States that the program that pays for premium assistance for people with HIV must remain cost neutral (i.e. can’t cost more than the old AIDS Drug Assistance Program cost). Orders DHHS to notify the joint HHS oversight committee if DHHS determines that they will run over these costs within the coming six months. States that the program that pays for premium assistance for people with HIV must remain cost neutral (i.e. can’t cost more than the old AIDS Drug Assistance Program cost). Orders DHHS to notify the joint HHS oversight committee if DHHS determines that they will run over these costs within the coming six months.
Provides $910,000 in non-recurring funding in FY 2019-20 and $680,000 non-recurring in FY 20-21 for youth tobacco prevention. No mention.
Provides $290,593 in recurring funds plus $8,750 in one-time funding to the state Office of the Chief Medical Examiner to provide for three medicolegal death examiners and administrative support to assist with the caseload in 31 central NC counties. Also appropriates $437,230 in recurring funds to replace short-term federal funding that paid for eight medicolegal death examiners. The federal grant expires September 30, so this new funding is effective October 1. Provides $290,593 in recurring funds plus $8,750 in one-time funding to the state Office of the Chief Medical Examiner to provide for three medicolegal death examiners and administrative support to assist with the caseload in 31 central NC counties. Also appropriates $437,230 in recurring funds to replace short-term federal funding that paid for eight medicolegal death examiners. The federal grant expires September 30, so this new funding is effective October 1.
Adjusts funding for the State Public Health Laboratory by $199,646 because of cut in Preventive Health Services Block Grant. No reduction in state appropriation, but a budget for SPHL adjusted downward. Adjusts funding for the State Public Health Laboratory by $199,646 because of cut in Preventive Health Services Block Grant. No reduction in state appropriation, but a budget for SPHL adjusted downward.
Adjusts funding for the state’s injury and violence prevention activities by $20,778 because of cut in Preventive Health Services Block Grant. No reduction in state appropriation, but a budget reduced. Adjusts funding for the state’s injury and violence prevention activities by $20,778 because of cut in Preventive Health Services Block Grant. No reduction in state appropriation, but a budget reduced.
Appropriates $50,000 in one-time funds to study incidences, possible causes and methods of abatement of ocular melanoma in/near the town of Huntersville. No mention.
Provides $90,000 in FY 19-20 and $70,000 in FY 20-21 for firearm storage awareness initiative. No mention.
Continues a competitive grant process to improve maternal and child health annually by having local health departments submit detailed proposals to use evidence-based programs to improve birth outcomes, improve the overall status of children under 5, and lower the state’s infant mortality rate. Grants to be awarded by the beginning of each fiscal year, and recipients need to issue a report to the state by December of each year detailing activities, budget, positions, funding sources, etc. Continues a competitive grant process to improve maternal and child health annually by having local health departments submit detailed proposals to use evidence-based programs to improve birth outcomes, improve the overall status of children under 5, and lower the state’s infant mortality rate. Grants to be awarded by the beginning of each fiscal year, and recipients need to issue a report to the state by December of each year detailing activities, budget, positions, funding sources, etc.
Removes $400,000 in recurring funding each FY from federal Maternal Child Health Block Grant funding to provide funds for the Nurse Family Partnership to support first-time parents who are at risk. Also provides $3.8M in one-time funding in FY 19-20 and $1.8M in one-time funding in FY 20-21 for the Nurse Family Partnership to support first-time parents who are at risk. Revised total for NFP: $7.25M in FY 19-20 and $5.25M in FY 20-21. Removes $400,000 in recurring funding each FY from federal Maternal Child Health Block Grant funding to provide for the Nurse Family Partnership to support first-time parents who are at risk. Revised total for NFP: $3.45M each FY.
Appropriates $4 million per fiscal year to local health departments to expand local infrastructure for infectious disease surveillance, detection, control and prevention. Money to be distributed thusly: $20,000 to each health department in the state for each county served, and the remainder distributed based on population density. Total budget for health promotion: $17.2M Total budget for health promotion: $13.2M
Carries forward language from the 2015 budget that cuts Planned Parenthood out of bidding for contracts to provide adolescent pregnancy prevention services by prohibiting any contracting with agencies which provide abortion. Carries forward language from the 2015 budget that cuts Planned Parenthood out of bidding for contracts to provide adolescent pregnancy prevention services by prohibiting any contracting with agencies which provide abortion.
Asks for a report on the premium assistance program that’s supplying medications to the state’s AIDS drug assistance program (ADAP) if DHHS determines that within six months, ADAP would no longer be cost neutral to the state. Asks for a report on the premium assistance program that’s supplying medications to the state’s AIDS drug assistance program (ADAP) if DHHS determines that within six months, ADAP would no longer be cost neutral to the state.
Moves $250,000 from the TANF block grant to provide funding for teen pregnancy prevention initiatives. Moves $250,000 from the TANF block grant to provide funding for teen pregnancy prevention initiatives.
Appropriates $400,000 each FY to Carolina Pregnancy Care Fellowship, a network of crisis pregnancy centers. Limits use of funds for administration to 15 percent. Appropriates $400,000 each FY to Carolina Pregnancy Care Fellowship, a network of crisis pregnancy centers. Limits use of funds for administration to 15 percent.
Appropriates $100,000 in funding to Mountain Area Pregnancy Services, a crisis pregnancy center, and limits administrative use of the funding to 15 percent. These monies to come out of the Division of Public Health funding allocation.
Reduces funding for women’s and children’s health services by $2.1M due to a decrease in the federal Maternal Child Health Block Grant. Reduces funding for women’s and children’s health services by $2.1M due to a decrease in the federal Maternal Child Health Block Grant.
Allows for any leftover from the $1.3 million in funding appropriated in 2017 to be carried forward into the next biennium and not revert back to the state. Limits use for administration to 10 percent. Allows for any leftover from the $1.3 million in funding appropriated in 2017 to be carried forward into the next biennium and not revert back to the state. Limits use for administration to 10 percent.
Appropriates $1.2 million per FY to expand a pilot program funded in 2017 and given to the Human Coalition, an organization that promotes childbirth as an alternative to abortion, teach parenting techniques and increase economic self-sufficiency. The pilot matched pregnant women with a mentor to guide the participant toward positive lifestyle changes and “help buid a stable family life for the duration of the pregnancy.” The statewide scale up is to provide direct services, supports, case management, referrals and outreach to at-risk populations. Participation limited to NC residents and those who are pregnant or parenting children under the age of 2. Allows for services to women who are post-abortion for six months. Limits use of funding for administration to 10 percent. Requires semi-annual reports on expenditures and program data. Repeals the initial pilot program. Appropriates $1.2 million per FY to expand a pilot program funded in 2017 and given to the Human Coalition, an organization that promotes childbirth as an alternative to abortion, teach parenting techniques and increase economic self-sufficiency. The pilot matched pregnant women with a mentor to guide the participant toward positive lifestyle changes, and “help buid a stable family life for the duration of the pregnancy.” The statewide scale up is to provide direct services, supports, case management, referrals and outreach to at-risk populations. Participation limited to NC residents and those who are pregnant or parenting children under the age of 2. Allows for services to women who are post-abortion for six months. Limits use of funding for administration to 10 percent. Requires semi-annual reports on expenditures and program data. Repeals the initial pilot program.
Appropriates a total of $160,000 in one-time funding for a Firearm Safe Storage Awareness Initiative, a two-year pilot which aims to educate the public about the imporance of safe storage of firearms and distribute gun locks, in particular to firearm owners who have children in their household. Funds the creation of a website and digital toolkit with information on safe storage, firearm safety resources, and resources for addressing domestic violence, hunter education and suicide prevention. Requires website/ toolkit to be completed by the beginning of the 2020 FY and statewide efforts in outreach to be undertaken using a contracted organization. Forbids any advocacy around creation of any policy regulating firearms. No mention.
Creates a new Office of Child Fatality Prevention within the DHHS Division of Public Health to oversee coordination of the state’s child fatality prevention system, eliminate “siloes and redundancy” and promote efficiency in the Child Fatality Prevention system and requires planning to restructure the system. Grants powers and duties to the office. Appropriates $150,000 in recurring funds in FY 19-20 and $300,000 in recurring funds in 2020 to establish the office. No mention.
Adds the director of the Juvenile Justice division of the corrections system to be a member of the Child Fatality Task Force. Codifies the different subcommittees within the CFTF, policies, procedures, leadership and duties. Also codifies and sets out responpsibilities for Child Fatality Prevention Team Coordinators, mandates annual reports, specifies confidentiality and records access guidelines and procedures, outlines functioning of the CFP Teams and Coordinators. No mention.
Reduces Division of Public Health budget for preventive health services by $246,929 because of a cut in the federal Preventive Health Services Block Grant. Reduces Division of Public Health budget for preventive health services by $246,929 because of a cut in the federal Preventive Health Services Block Grant.

Division of Services for the Blind/Deaf/Hard of Hearing

Division of Services for the Blind/Deaf/Hard of Hearing
Appropriates $169,513 in state matching funds for the federal Basic Support Vocational Rehabilitation grant to add jobs/training opportunities for people with sensory disabilities. Appropriates $169,513 in state matching funds for the federal Basic Support Vocational Rehabilitation grant to add jobs/training opportunities for people with sensory disabilities.

Division of Social Services

Division of Social Services
Eliminates three unfilled positions, saving $126,899 from the General Fund outlay (Human Services Planner Evaluator, Business Officer, Contract Specialist)
Stipulates that one-time funding given to DHHS in each FY be used to provide monthly financial assistance to adult care homes that receive state/county special assistance funds. Half the cost of enhanced payments to ACHs are to come from DHHS, totaling $34/month per resident, only for residents who are eligible, not for anyone whose payments are “pending.” Limits the use of these funds to *only* offsetting cost of serving residents, with counties paying half of this cost. Temporary assistance ends in June 2021. Stipulates that one-time funding given to DHHS in each FY be used to provide monthly financial assistance to adult care homes that receive state/county special assistance funds. Half the cost of enhanced payments to ACHs are to come from DHHS, totalling $34/month per resident, only for residents who are eligible, not for anyone whose payments are “pending.” Increases the monthly payment to $70/month in the FY 20-21. Limits the use of these funds to *only* offsetting cost of serving residents, with counties paying half of this cost. Temporary assistance ends in June 2021.
Limits the amount used by DSS to administer the state/county special assistance program to $250,000/year. The section does not obligate the NC General Assembly to provide these funds and notes these payments do not constitute an entitlement. Limits the amount used by DSS to administer the state/county special assistance program to $250,000/year. The section does not obligate the NC General Assembly to provide these funds and notes these payments do not constitute an entitlement.
Notes approval of DHHS’ state plan for spending TANF (Temporary Assistance for Needy Families) monies covering through September 2022. Designates Beaufort, Caldwell, Catawba, Lenoir, Lincoln, Macon and Wilson counties as “electing counties” with some flexibility in administering the plan and delivering services. Budget language holds those counties harmless for their allocations for the first year and stipulates what to do in the case of insufficient or excess funds. (same as 2017, dates change) Notes approval of DHHS’ state plan for spending TANF (Temporary Assistance for Needy Families) monies covering through September 2022. Designates Beaufort, Caldwell, Catawba, Lenoir, Lincoln, Macon and Wilson counties as “electing counties” with some flexibility in administering the plan and delivering services. Budget language holds those counties harmless for their allocations for the first year and stipulates what to do in the case of insufficient or excess funds. (same as 2017, dates change)
Stipulates that the Intensive Family Preservation Services Program to provide services to children and families in cases of abuse, neglect and dependency where a child is at imminent risk of removal from the home. These sections set out reporting, data collection and follow-up requirements for programs receiving federal and state monies to do this work. (same as 2017 budget) Stipulates that the Intensive Family Preservation Services Program to provide services to children and families in cases of abuse, neglect and dependency where a child is at imminent risk of removal from the home. These sections set out reporting, data collection and follow-up requirements for programs receiving federal and state monies to do this work. (same as 2017 budget)
Sets out budget guidelines for how DHHS Division of Social Services can use funds to support the provision of foster care services and extension of guardianship services for youth who reach 18 and are going to school, trade school, training, are working at least half time, or have a disability limiting their participation in any of these activities. Limits the expenses to be incurred for the Guardianship Assistance Program. Sets out that GAP rates paid to legal guardians will be at the same rate as previously established foster care room and board rates. Sets out budget guidelines for how DHHS Division of Social Services can use funds to support the provision of foster care services and extension of guardianship services for youth who reach 18 OR who left foster care at the age of 16 and are going to school, trade school, training, are working at least half time, or have a disability limiting their participation in any of these activities. Limits the expenses to be incurred for the Guardianship Assistance Program. Sets out that GAP rates paid to legal guardians will be at the same rate as previously established foster care room and board rates.
Sets the rate for how much DHHS can pay for the educational needs of foster youth aging out of the foster care system and special needs children adopted when they were older. Appropriates $50,000 per year to administer the scholarship funds for these foster children. Also appropriates $339,493 per year for a contract to administer the child welfare post-secondary support program. Stipulates the money can only be used to pay for attendance at a public institution in NC. (Identical to 2017 budget) Sets the rate for how much DHHS can pay for the educational needs of foster youth aging out of the foster care system and special needs children adopted when they were older. Appropriates $50,000 per year to administer the scholarship funds for these foster children. Also appropriates $339,493 per year for a contract to administer the child welfare post-secondary support program. Stipulates the money can only be used to pay for attendance at a public institution in NC. (Identical to 2017 budget)
Orders DHHS/Child Support Services Section (NCCSS) to retain up to 15 percent of annual federal incentive payments and allocate no less than 85 percent to enhance child support services by consulting with county officials to see what would improve centralized services, use the money for improvement. The money cannot be used to supplant state expenditures for those services and write new rules for calculating and distributing the funds. This has been modified since 2015 budget. (Identical to 2017 budget) Orders DHHS/Child Support Services Section (NCCSS) to retain up to 15 percent of annual federal incentive payments and allocate no less than 85 percent to enhance child support services by consulting with county officials to see what would improve centralized services, use the money for improvement. The money cannot be used to supplant state expenditures for those services and write new rules for calculating and distributing the funds. This has been modified since 2015 budget. (Identical to 2017 budget)
NCCSS is to use the rest of the money noted above to improve effectiveness and efficiency, using the measures established by federal officials. That means looking at current ways of distributing funds and seeing if there’s a better way. If another method is determined, phase it in over a four-year period. (Identical to 2017 budget) NCCSS is to use the rest of the money noted above to improve effectiveness and efficiency, using the measures established by federal officials. That means looking at current ways of distributing funds and seeing if there’s a better way. If another method is determined, phase it in over a four-year period. (Identical to 2017 budget)
NCCSS is to have county DSSs submit annual plans on how any funding will improve their programs as a condition for receiving incentive funding and report on how that funding has improved the programs, providing proof and explaining any deviations from their plans. Finally, NCCSS has to report to the legislature on their progress by November 1 of each year. (Identical to 2017 budget) NCCSS is to have county DSSs submit annual plans on how any funding will improve their programs as a condition for receiving incentive funding and report on how that funding has improved the programs, providing proof and explaining any deviations from their plans. Finally, NCCSS has to report to the legislature on their progress by November 1 of each year. (Identical to 2017 budget)
Changes to the Child Welfare System – DHHS is ordered to continue implementing changes driven by a federal program improvement plan to bring NC into compliance with national standards for child welfare policy and practices. Orders Division of Social Services to notify the legislative oversight committee within 30 days of implementation of the program improvement plan, with a final report submitted no later than three months after. Changes to the Child Welfare System – DHHS is ordered to continue implementing changes driven by a federal program improvement plan to bring NC into compliance with national standards for child welfare policy and practices. Orders Division of Social Services to notify the legislative oversight committee within 30 days of implementation of the program improvement plan, with a final report submitted no later than three months after.
Changes to the Child Welfare System – orders DHHS to get child welfare component of NC FAST system online and orders Division of Social Services to notify the legislative oversight committee within 30 days of implementation of the child wefare component, with a final report submitted no later than three months after. Changes to the Child Welfare System – orders DHHS to get child welfare component of NC FAST system online and orders Division of Social Services to notify the legislative oversight committee within 30 days of implementation of the child wefare component, with a final report submitted no later than three months after.
Appropriates $914,790 to create 11 new positions to provide technical assistance and program monitoring to workers in county DSS offices. This fulfills the federal requirement to monitor activity in all 100 counties. Appropriates $426,978 to create five new positions to provide technical assistance and program monitoring to workers in county DSS offices. This fulfills the federal requirement to monitor activity in all 100 counties.
Orders DHHS/DSS to continue implementing an evidence-based pilot program started in 2016 to improve care and access to food and other public benefits for dual (Medicare and Medicaid) eligible seniors to improve their health and independence while reducing costs. DSS is working with a not for profit to identify seniors eligible for SNAP, create an outreach program, sign seniors up for benefits and do measurement and evaluation. Appropriates $420,000/ FY. Orders a report due in February of each year and stipulates that any leftover funds not revert to the state, but rather be available to expand the pilot or included in other benefits programs. Orders DHHS/DSS to continue implementing an evidence-based pilot program started in 2016 to improve care and access to food and other public benefits for dual (Medicare and Medicaid) eligible seniors to improve their health and independence while reducing costs. DSS is working with a not for profit to identify seniors eligible for SNAP, create an outreach program, sign seniors up for benefits and do measurement and evaluation. Appropriates $420,000/ FY. Orders a report due in February of each year and stipulates that any leftover funds not revert to the state, but rather be available to expand the pilot or included in other benefits programs.
Continues a $500,000 “Foster Care Transitional Living Initiative Fund” to support transitional living services that produce good outcomes for foster youth aged 17-21 that was created in the 2017 budget. Fund will support a demonstration project with services provided by Youth Villages. Goals are to support young people as they transition from foster care, identify cost savings in services that facilitate that transition, and establish a best-practices program available to all kids in transition from foster care. Part of the strategy is to form public-private partnership with state matching funds for the biennium, where the private partner is required to match 25 percent of the state funds. Continues a $500,000 “Foster Care Transitional Living Initiative Fund” to support transitional living services that produce good outcomes for foster youth aged 17-21 that was created in the 2017 budget. Fund will support a demonstration project with services provided by Youth Villages. Goals are to support young people as they transition from foster care, identify cost savings in services that facilitate that transition, and establish a best-practices program available to all kids in transition from foster care. Part of the strategy is to form public-private partnership with state matching funds for the biennium, where the private partner is required to match 25 percent of the state funds.
Orders a final report on the transfer of responsibility over some social services from the state of NC to the Eastern Band of the Cherokee once implementation is completed. No timeline specified. Orders a final report on the transfer of responsibility over some social services from the state of NC to the Eastern Band of the Cherokee once implementation is completed. No timeline specified.
Provides one-time appropriation of $500,000 in FY 19-20 for Child Advocacy Centers. Up to $100,000 will go to centers in good standing and $100,000 to Children’s Advocacy Centers of NC, Inc. for operations. Appropriates an additional $1.9M per FY for Intensive Family Preservation Services. Moves funding from the TANF Block Grant to the Social Services Block Grant and uses $1,582,000 of the SSBG to fund Child Advocacy Centers to the tune of $100,000/center, plus and $100,000 to Children’s Advocacy Centers of NC, Inc. for operations. Provides $1M per FY (recurring funding) from the General Fund for Intensive Family Preservation Services. Moves funding from the TANF Block Grant to the Social Services Block Grant and uses $1,582,000 of that SSBG money for funding Child Advocacy Centers to the tune of $100,000/center, plus and $100,000 to Children’s Advocacy Centers of NC, Inc. for operations.
Adds $2,250,000/FY in non-recurring funds to the Permanency Innovation Initiative Fund created in the 2017 budget which supports transitional living services that produce good outcomes for foster youth aged 17-21. Fund supports a demonstration project with services provided by Children’s Home Society. Goals are to support young people as they transition from foster care, identify cost savings in services that facilitate that transition, and establish a best-practices program available to all kids in transition from foster care. Makes some changes to the fund requirements, stipulating that CHS support counties’ DSS workers as well as families who are involved with these children. Stipulates that federal funds coming into these programs enhance, rather than replace, existing dollars and appropriations. Adds $1,500,000/ FY in non-recurring funds to the Permanency Innovation Initiative Fund created in the 2017 budget which supports transitional living services that produce good outcomes for foster youth aged 17-21. Fund supports a demonstration project with services provided by Children’s Home Society. Goals are to support young people as they transition from foster care, identify cost savings in services that facilitate that transition, and establish a best-practices program available to all kids in transition from foster care. Makes some changes to the fund requirements, stipulating that CHS support counties’ DSS workers as well as families who are involved with these children. Stipulates that federal funds coming into these programs enhance, rather than replace, existing dollars and appropriations.
Reduces the funding from the TANF Block Grant going to Work First Family Assistance because of a declining caseload. Reduction is $4.2M/FY. Reduces the funding from the TANF Block Grant going to Work First Family Assistance because of a declining caseload. Reduction is $4.2M/FY.
Provides an additional $300,000/FY grant to MARC, Inc. (Marketing Association for Rehabilitation Centers) to help create employment opportunities for people who are “chronically underemployed.” Notes increase of $4.5M for for federal Community Services Block Grant, increases appropriation for employment benefits to “address the effects and causes of poverty and to assist low-income individuals to become self-sufficient and independent.”
Reduces funding for the Low Income Heating Energy Assistance Program Block Grant by $3.7M because of “reduced federal availability.” Total amount to spend $40.3M. This includes a reduction of $1.5M to the Weatherization Program, so now a total of $9.8M to be spent in FY 19-20 and $9.6M in FY 20-21. This includes a reduction of $605,012 for DSSs to administer the program and additional funding of $435,978 for the Heating and Air Repair and Replacement Program. Reduces funding for the Low Income Heating Energy Assistance Program Block Grant by $3.7M because of “reduced federal availability.” Total amount to spend $40.3M. This includes a reduction of $1.5M to the Weatherization Program, so now a total of $9.8M to be spent in FY 19-20 and $9.6M in FY 20-21. This includes a reduction of $605,012 for DSSs to administer the program and additional funding of $435,978 for the Heating and Air Repair and Replacement Program.
Reduces funding for the LIHEAP crisis intervention program by $3.7M, which assists low income recipients with emergency heating or cooling costs because of reduced federal availability. Reduces funding for the LIHEAP crisis intervention program by $3.7M, which assists low income recipients with emergency heating or cooling costs because of reduced federal availability.
Allocates $24.2M in FY 19-20 and $20.5M in FY 20-21 of Community Services Block Grant funding to Community Action Agencies. Allocates $22.4M in each FY of Community Services Block Grant funding to Community Action Agencies.
Appropriates $80,000 in FY 19-20 and $150,000 in FY 20-21 to create a pilot program that would create a standardized process for each child entering foster care to have a trauma assessment. Up to three LME/MCOs to participate in the project, with the intent that by January 2020, all the LMEs and county DSSs start conducting the assessments. The pilot should include support for training in trauma-informed care and the use of the screening tool, with an eye toward maintaining fidelity to the model program. Defines what constitutes “trauma.” Orders a report to be made to legislative oversight committee by April 2022. No mention.
Orders a report on DHHS’ implementation plan for the federal Families First Prevention Services Act, with a focus on how to maintain continuum of care for children who are currently in larger institutions. Plan should include recommendations for changes to Medicaid service definitions and how all entities (e.g., tribes, new managed care organizations) will implement and reimburse for services. Orders DHHS’ Division of Social Services to hold quarterly calls with stakeholders, changing to semiannually in October 2019. No mention.
Orders DHHS to move $1.5M/year out of the Medicaid budget line designated for helping people with I/DD to transition to community-based facilities and instead have the funding go to the Division of Social Services to become matching money for any counties that wish to create new “quality assurance” positions in child welfare in their county DSSs. Stipulates the percentage distribution of the funds (distributed by population). Notes the training requirements. Appropriates $750,000/year to be used to provide a 50 percent match to county DSSs to create new quality assurance positions for child welfare within those departments. Funds distributed based on a prioritization of need. Funds/positions will be allocated based on the county population, with each county that has more than 1 percent of the NC population (about 103,000 residents) receiving one worker and smaller counties to share workers. DHHS/DSS is required to create a quality improvement training plan for all staff, sets out criteria for the training.
Takes $5,000/year from the Group Home Wage Increase fund and allocates it to the Division of Social Services to create a web-based report on TANF (Temporary Assistance for Needy Families) expenditures that will include the number and amount of out-of-state expenditures of TANF funds and details about each transaction. Orders semi-annual report on the spending. Orders $26,250 to have the Division of Social Services create a way for a contractor to collect data on TANF (Temporary Assistance for Needy Families) and SNAP (Supplemental Nutrition Assistance Program) expenditures. Data to be collected should include the number and amount of both in- and out-of-state expenditures in each program and details about each transaction. Orders semi-annual report on the spending. Orders DHHS to do data analysis and report how the data is examined to detect fraud and abuse in both TANF and SNAP.
No mention. Details increases in foster care assistance and adoption assistance rates. 8.2 percent increase for children 0-5, 12.6 percent increase for children 6-12, 10 percent increase for children 13-21, effective July 2020. Adds $6.9M in recurring funding starting in FY 20-21.
No mention. Adds $300,000 in one-time funding to create a two-year pilot, four-county project to help foster children get access to comprehensive health care that includes behavioral health services. The idea is to create continuity of care, provide an alternative to therapeutic foster care and to provide trauma-informed care no matter what foster care placement the child is in (as opposed to moving the child from “higher-level” therapeutic foster care placements back to “lower” level placements once the child has stabilized. The pilot would take place in Davie, Forsyth, Rockingham and Stokes counties in conjunction with the LME/MCOs that manage care in those areas. Calls for a final report that lists costs, outcomes, details of what services were delivered, and a plan for potential replication in other counties.
Anticipates reductions in the Special Assistance caseload, reduces by $3M in FY 19-20 and by $3.12M in FY 20-21 Anticipates reductions in the Special Assistance caseload, reduces by $3M in FY 19-20 and by $5M in FY 20-21
Increases the personal needs allowance for Medicaid-paid residents in assisted living/adult care homes from $46/month to $70/month, the first change since 2003. Provides $3.3M in each FY to cover the cost. Also adds $750,000 in FY 19-20 and $1M in 20-21 to cover anticipated increase in enrollment associated with this policy change. Increases the personal needs allowance for Medicaid-paid residents in assisted living/ adult care homes from $46/month to $58/month in FY 19-20. Increases the personal needs allowance in FY 20-21 to $70/month, the first change since 2003. Provides $3.3M in FY 19-20 and $7M in 20-21 to cover the cost.
Sets the monthly rate for state-county special assistance at $1,182/month and $1,515/month for residents of Alzheimer’s/dementia special care units. (This is the same as in the past biennium.) Sets the monthly rate for state-county special assistance at $1,182/month and $1,515/month for residents of Alzheimer’s/dementia special care units. (This is the same as in the past biennium.)
No mention. Allows DHHS to authorize special assistance payment for someone who would otherwise qualify if they were living in an adult care home but is living in the community. The amount is to be what’s paid to an adult care home, but it could be less if a case manager determines a lesser amount is “appropriate.” Requires that DHHS representative perform a functional assessment of the person.
Authorizes the Health and Human Services secretary to waive the current 15 percent cap on payments for in-home Special Assistance as necessary, only until the end of the biennium, June 30, 2021 No mention.
Provides $2M in one-time funding to Florence Crittenden Services, Inc., in Charlotte, which provides “comprehensive health, education and social services for at-risk or pregnant adolescents.” Funds are to assist with relocation and services to support clients. No mention.

Division of Vocational Rehabilitation Services

Division of Vocational Rehabilitation Services
Provides $92,468 in funding to pull down federal matching funds to create five positions to serve the Division of Vocational Rehabiltation Services as well as services for the blind. The funds are to help people currently on SSI disability to seek work and become more financially independent. Provides $92,468 in funding to pull down federal matching funds to create five positions to serve the Division of Vocational Rehabiltation Services as well as services for the blind. The funds are to help people currently on SSI disability to seek work and become more financially independent.
Appropriates $300,000/ FY to the National MS Society to help provide home modifications and assistance with home mods to people with MS to help them stay at home. Appropriates $300,000 only in FY 2020-21 to the National MS Society to help provide home modifications and assistance with home mods to people with MS to help them stay at home.
Provides $540,000 in one-time funds in FY 19-20 and $270,000 in one-time funds in FY 20-21 to create a statewide inventory of assistive technology equipment to be used for assessments, training and short-term loans. Provides $810,000 in one-time funds in FY 19-20 only to create a statewide inventory of assistive technology equipment to be used for assessments, training and short-term loans.

Legislature makes another attempt at creating association health plans

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Legislature makes another attempt at creating association health plans - North Carolina Health News

After failing to create alternative health insurance plans for small businesses last year, General Assembly members propose a new bill to make them legal in North Carolina.

By Rose Hoban

Lobbyist Andy Ellen, who represents more than 25,000 store owners who are part of the North Carolina Retail Merchants Association at the state legislature, says the greatest number of calls his organization receives is from small business owners looking for help getting health insurance for themselves and their workers.

“We have some very small independent businesses, you know, that pay $25,000 plus in coverage for them and their families,” Ellen said. “They end up in the individual market because they don’t qualify to get into the larger group market.”

So, Ellen was pleased last week when Republican members of the state Senate introduced a bill to allow association health plans, or AHPs, in North Carolina. The bill would bring the state in line with federal rules finalized last fall that allow businesses to band together to purchase insurance as part of one big pool.

When President Donald Trump signed an executive order paving the way for businesses to create AHPs, the Merchants Association’s  “phones started ringing off the hook,” Ellen said. “Our members have been clambering for this.”

Another bite at the apple

The new federal regulations allow businesses that are similar or located in the same geographic location, to band together to offer health insurance.

Following the Trump administration’s announcement, North Carolina lawmakers proposed a measure that would allow for such plans in the state, but that bill was drafted narrowly to essentially allow one organization in the state, the Farm Bureau, to sponsor a health insurance plan for almost anyone who wanted to buy in. The catch? The Farm Bureau’s plan would allow for the type of underwriting that used to be commonplace before passage of the Affordable Care Act in 2010.

That bill eventually failed.

Later in the year, the state’s restaurant and lodging association attempted to create its own AHP, but it ran into a brick wall because state law did not yet conform with the new federal rules, which were finalized in late August, after the legislature had adjourned for the year.

The bill filed last week would allow businesses to join together to purchase plans, so long as there’s a sponsoring organization to manage it. That puts North Carolina law in line with the federal rules.

“What they’re proposing to do is expand the definition of an employer for this purpose,” explained Sam Krause, a California attorney who specializes in federal insurance law. In AHPs of the past, “the association had to do something other than provide insurance to its members, it had to have some other type of significant robust type of activity. For example, think of an AARP, where it provides all these benefits and services to its members but they also have a plan that you can get into.”

“That would be amazing,” said Aaron Nelson, head of the Chapel Hill/ Carrboro Chamber of Commerce, which has about a thousand small business members with a total of about 80,000 employees. “Our chamber and chambers across the state should be very interested in this. We would love to find a way to help small businesses find access to high quality, lower cost health insurance.”

He starting riffing on how his organization could offer an AHP and perhaps join with other local chambers to build an even bigger risk pool.

But he had one question: Would his chamber find an insurer to issue such a plan?

What is underwriting?

Health insurance underwriting used to be common practice, one that made it harder for people with pre-existing conditions, or who had greater risks for disease, to get insurance.

Before the Affordable Care Act, health insurers would adjust premiums based on many risk factors: gender, occupation, age, prior health status and so forth, resulting in higher premiums for people who were older or who had a pre-existing condition that required more care.

The ACA did away with that, imposing a “community rating” that made it cheaper for people with pre-existing conditions to buy plans. Under the community rating rules, the cost of insurance is calculated based on everybody buying an ACA plan; pre-existing conditions and other factors that drive up insurance costs are spread across everyone in that plan.

“The people who would be worse off are those who need community-rated guaranteed insurance,” said health economist Dave Anderson from Duke University’s Margolis Center for Health Policy. “The AHP won’t be adequate for their needs.”

Difficult market

Currently, people who own small businesses, either sole proprietors or those who run businesses with fewer than 51 employees, are not required to provide health insurance to employees. Many businesses want to provide that perk, but find it too expensive.

According to the Kaiser Family Foundation, only 21 percent of North Carolina firms with fewer than 50 employees offer health insurance, compared to 94 percent of businesses with 50 employees or more. Larger businesses can self-insure, essentially become an insurance company themselves and be exempted from most ACA rules, or they can use their size to negotiate a better deal from a big insurance company than small businesses usually can.

“The theory behind the AHP is that you allow people who would otherwise not be able to afford to provide insurance to employees to do so at a better rate because you’re using a larger pool,” said Krause, the lawyer.

There are lots of questions about AHPs, in large part because in the past they’ve had problems with solvency and because they don’t have as many consumer protections. Groups that have members with pre-existing conditions would have higher premiums than those workplaces with younger and healthier members.

Advocates claim AHPs will help create bigger risk pools to help smooth out premiums across more people.

Initially, when Trump proposed creating the AHPs, advocates worried that the new federal rules would allow for so-called “skinny” plans that covered catastrophic coverage and little else. The rules released by the U.S. Department of Labor last fall called for plans that were a little more robust and also tightened rules to avoid solvency problems of AHPs of the past.

For example, the new North Carolina bill calls for AHPs to keep some of the protections of the Affordable Care Act, such as requiring coverage for people with pre-existing conditions and allowing parents to keep their children on their plans up to age 26.

Krause made the point that if a chamber of commerce was going to sell plans, they have an incentive to sell the best plans they can get, “it has to be a plan that’s attractive for some reason.”

He did say that transparency around what the plans cover, what prices they pay to providers and the network of doctors and hospitals that accept the insurance would be important factors. The General Assembly bill allows for AHPs ranging from cheaper “skinny” plans to more robust — and more expensive — offerings.

Running with scissors

Krause’s colleague David McFarlane said AHPs could work for some people, but they are also risky. Many states, he said, might rush into allowing these without enough guardrails in place and without creating rules to guarantee transparency for people who buy the plans.

He likened it to “running with scissors.”

And health economists have doubts, too. Anderson, the Duke economist, said the plans will likely have a limited effect on North Carolina’s individual market, a sector of the health insurance market where costs are among the highest.

Anderson pointed out that many lower-income workers are already doing well in the exchanges created by the ACA, thanks to generous federal tax subsidies for families earning less than 250 percent of the federal poverty level ($62,750 for a family of four).

Those subsidies disappear for AHPs.

“An association health plan might be more attractive to folks who are earning between 300-400 percent of the federal poverty level ($75,300- $100,400) because they don’t get much subsidy on the ACA’s exchanges,” he said.

An AHP’s benefit would only really help people who are relatively healthy, Anderson argued, as, over time, plans would likely get more expensive for older workers who are more likely to have chronic health conditions. As plans get more expensive, he said, younger, healthier workers would go looking for cheaper options and leave behind their unhealthier colleagues who’d have little choice but to pay more.

“Where it could hurt is for individuals who make more than 400 percent of federal poverty ($103,000 for a family of four) who have chronic conditions who have to get insurance, and the AHP is designed to be non-supportive of their medical needs,” Anderson said. “The easiest way to do that is not covering the major… hospitals.”

He said protections for people with pre-existing conditions written into the law could also be weakened by plans that make chronic care patients jump through more hoops to get services or by charging high annual deductibles.

Undermining the ACA?

Anderson said he wasn’t too worried about AHPs undermining North Carolina’s robust participation in the subsidized marketplace created by the Affordable Care Act.

About half a million North Carolinians bought individual insurance plans during last fall’s ACA signup period, with most of them qualifying for a subsidy to offset premium costs.

Wake Forest University health policy professor Mark Hall said the effect of AHPs on the ACA exchanges is potentially limited.

He said that for small groups this would provide a way for companies to choose between buying coverage that’s “fully regulated and only partially regulated coverage.”

Hall noted that premiums on the exchanges have been “fairly stable.”

Both Hall and Anderson said having AHPs available would inevitably mean healthier workers leaving the Affordable Care Act exchanges to jump into an AHP. But they agreed it was hard to predict how large that effect would be.

“It would be a shame to implement a measure that creates problems for a market segment that currently appears to be doing okay, relatively speaking,” Hall wrote in an email to NC Health News.

Sign at a lonely crossroads encouraging enrollment in Obamacare insurance

In the Final Week of Enrollment, Obamacare Marketplace Offers Many Avenues to Getting Insurance

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In the Final Week of Enrollment, Obamacare Marketplace Offers Many Avenues to Getting Insurance - North Carolina Health News

But experts warn that consumers would do well to read the fine print as they choose plans to cover themselves and their family members for 2019.

By Yen Duong and Rose Hoban

If you thought an Obamacare plan might cost you too much, think again. In fact, you could pay nothing.

As this year’s enrollment period for insurance through the Affordable Care Act draws to a close, advocates are making the point that some plans could actually cost nothing, after tax credits.

Looking for help enrolling? Contact the NC Navigator Consortium or call: 1 855 733 3711
An analysis released Tuesday by the Kaiser Family Foundation finds that about 296,892 North Carolinians could purchase a so-called bronze plan which, after a tax credit, would essentially be free. That 37 percent of uninsured North Carolinians who are not eligible for Medicaid and are under 65 are eligible for these high-deductible $0 premium plans.

But Adam Zolotor from the North Carolina Institute of Medicine said that consumers should look at their options carefully.

“If you actually have need for health care you could end up spending more money on a bronze than a silver plan,” he explained. “That’s because under silver plans, which cost a little bit more, the federal government not only pays for a tax credit but also gives consumers help covering their out-of-pocket costs.”

Sponsored

“If someone is pretty healthy and not expecting to go to the doctor except for an annual physical they might benefit from a bronze plan, it allows them some measure of insurance against a major calamity,” he said. “Having a bronze plan for some people actually winds up meaning that they have more out-of-pocket expenses.”

Read the fine print

Though a free bronze plan may sound tempting, the average deductible for bronze plans is $6,258 and there’s no help on bronze plans for out-of-pocket costs. That means a consumer has to pay off that deductible before the health insurance kicks in and starts paying for services.

ACA plans are organized into metal tiers, based on what percentage of your health costs they cover, as listed on healthcare.gov. Bronze plans will pay for 60 percent of health costs, leaving consumers who buy them responsible for 40 percent of any costs to come out of their pockets.

In contrast, silver plans cover 70 percent of costs and typically have lower deductibles, ranging from $239 to $3,169 in 2019. On top of that, the federal government provides help to cover out-of-pocket costs.

People who make less than 250 percent of the federal poverty level are eligible for help with out- of-pocket costs in the ACA marketplace, but they can only use these extra savings on silver plans.

The Kaiser Family Foundation offers an online calculator to estimate how much plans could cost.

For instance, a family of four in Charlotte that makes the median household income in Charlotte of $58,202 may be better off paying $373 a month (7.7 percent of their income) for a silver plan with lower deductibles than choosing a $0 bronze plan. This median income is 232 percent of the federal poverty level.

A family of four in Henderson that makes the median household income in Henderson of $26,256 would pay $46 a month for a silver plan, or $0 for a bronze plan. This median income is 105 percent of the federal poverty level.

Those silver plans premiums cost more per month than bronze plans, so there’s a trade-off: pay per month up front for a silver plan with better coverage, or pay next-to-nothing up front for a bronze plan and take your chances you don’t get sick and saddled with high out of pocket costs.

Zolotor said it would be wise to sit down with an enrollment counselor or a navigator to discuss what works best. He said that, for instance, low-income adults who get their care at federally qualified community health clinics could be paying very little if they’re being charged on a sliding scale already. Having insurance might not actually work for those people. Zolotor also worried that those low-income people who qualify for their local hospital’s charity care program might be on the hook for more out-of-pocket costs if they end up in the hospital and they have purchased that bronze-level coverage.

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“We might wind up seeing people with more out-of-pocket expenses because they’re newly insured,” he said. “I don’t think that’s the system they’re shooting for.”

Mark Van Arnam, head of the NC Navigator Consortium, said that while those bronze plans look tempting, the folks working with him are careful to comb through the policies with potential enrollees.

“If they take prescription drugs that they’re included in the formularies for these plans, we want to make sure that their costs are minimized and there’s no out-of-network costs that may increase the price for them,” he said.

Snow delay?

As of Dec. 1, 184,891 North Carolinians had signed up insurance, a number that’s down from last year, when 209,050 people had signed up by the start of December.

Van Arnam said he’s been driving around the state talking to people and attending enrollment events.

“I think I spend more time in my car than I do in my own bed at home,” he said during an interview with NC Health News conducted as he was driving. “I’m living off of Diet Coke and adrenaline.”

NC Board of Nursing Protecting the Public y Regulating the Practice of NursingHe said that while enrollment is lagging somewhat, there are some extenuating circumstances, the first being the elimination of the individual mandate that penalized people for not purchasing insurance. And, he said, the state’s improved job market has softened demand.

“There are people who are going out and getting employer based coverage, so that also means there are less folks that are needing to use the marketplace,” Van Arnam said.

Nonetheless, as the Saturday midnight deadline looms, activity has ticked up in both the state’s call center and online.

“We know always that folks are natural procrastinators, and they tend to act in this last week of open enrollment,” he said.

Van Arnam worried that this past weekend’s winter storm forced the cancellation of a number of walk-in enrollment events and those where people had signed up in advance for appointments.

“We’re concerned about that, we want to be sure that everyone has the opportunity to take action and get enrolled,” Van Arnam said.

He noted that his organization has petitioned the federal Centers for Medicare and Medicaid Services for a deadline delay of several days for people affected by the snow, but he has yet to hear back from federal officials.

shows a cabbage field extending off into the distance. Farmers are some of the people who could benefit from association health plans

N.C. Organizations Worry, Hope as Feds Rewrite Association Health Plan Rules

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N.C. Organizations Worry, Hope as Feds Rewrite Association Health Plan Rules - North Carolina Health News

The Trump administration hopes that a rewrite of federal association health plan rules spurs a new generation of less expensive health insurance products. But skeptics say such plans may not be all they’re cracked up to be.

By Mark Tosczak

If everything goes as N.C. Farm Bureau Mutual Insurance President Larry Wooten hopes, this time next year North Carolina farmers and others who work for agricultural businesses could have another health insurance choice: AgCareFirst.

Eligible businesses would pay at least 50 percent of the monthly premiums and covered employees the remaining balance. Wooten says the Raleigh-based nonprofit insurer, which is owned by its members, has sold Blue Cross Blue Shield of North Carolina health plans to members for years.

Soaring premiums in plans offered by Blue Cross and other insurers have members looking for choices.

“We’ve had people calling, crying,” Wooten says. “They’re making decisions on whether they pay a mortgage, almost, or whether they pay health insurance. That’s how bad it is. It’s just terrible.”

Right now, the federal government is revising rules that govern association health plans. AgCareFirst will only launch if those rules allow the company to charge different premiums to different employers, depending on the health status and other differences among employees — a process called “underwriting.”

“If we can’t underwrite, then it won’t work for us,” Wooten said.

Arguments over proposed rules

Underwriting used to be common practice, one that made it harder for people with pre-existing conditions, or who had greater risks for disease, to get insurance. The Affordable Care Act eliminated that for many people, because the law largely eliminated underwriting, instead  guaranteeing that people with pre-existing conditions could get insurance.

The U.S. Department of Labor hasn’t issued final regulations yet. But earlier this year, during a public comment period on the association health plans, at least a dozen organizations and individuals with North Carolina ties submitted public comments on the draft regulations.

Supporters argue the plans will allow small businesses to band together, increasing their purchasing clout so they can negotiate better prices for drugs and health care services.

But Mark Hall, director of the Health Law and Policy Program at Wake Forest University, submitted comments disputing the notion that the plans can reduce costs.

“There is no credible published evidence that pooled purchasing arrangements, including AHPs themselves (which have long existed), have been able to do so,” he wrote in comments submitted to the federal government. “All of the published evidence is to the contrary – documenting that they have not been able to reduce underlying administrative or medical costs.”

Critics also say such association plans might reduce premiums by cutting benefits, leaving people with less protection than they expect from a health insurance plan in the event of a serious medical issue. And, they argue, association health plans could weaken existing small group insurance plans and plans sold on the insurance exchanges created by the ACA, ultimately driving up premiums for the people still covered by them.

The Farm Bureau’s request to charge different employers different premiums depending on the health status of their employees and dependents may be critical to its ability to offer a plan. But others say that’s a bad idea.

‘Be particularly skeptical’

“The ability to reintroduce medical underwriting is really troubling,” said Robert Seehausen, senior vice president at Winston-Salem-based Novant Health.

Seehausen and others are worried that new regulations could permit association health plans that don’t provide the same basic benefits as other health coverage currently required under the ACA, such as maternity care. They also worry about plans that won’t provide enough coverage for serious medical issues.

“Before the ACA and some of the standardization that came with it, there was a whole category of insurance called mini-meds,” Seehausen said. “We had way too many examples where our financial assistance counselors were the ones educating consumers about their benefits and how little they were really covered.”

For employees who want to be sure they don’t end up with an unexpected hospital bill, “Consumers are going to have to be particularly skeptical and kick the tires hard on the provider networks on the benefits,” Seehausen said.

Cherry-picking cheaper members

The other main threat that skeptics see from these association health plans are their potential to lure younger, healthier people away from ACA exchange plans as well as, perhaps, small-group insurance plans, which are often used by small businesses.

Sponsored

Those plans, under the ACA, are only able to vary rates between individuals based on age and tobacco use — and even then, only within limits. Other factors, such as gender, past medical claims or health status, can’t be used to set rates.

So if younger, healthier people sign up for an association plan instead of a small group plan or an ACA exchange plan, the people who are left behind are likelier to be sicker on average and more expensive to take care of.

“That means higher premiums,” said Brendan Riley, a health policy analyst at the liberal-leaning N.C. Justice Center.

“Ultimately, we see the move to proliferate association health plans as really being designed to get more people into bare-bones coverage,” he said. “There’s nothing here that’s addressing the actual fundamental cost of care.”

Existing associations concerned

Though there are both critics and supporters of the proposal to expand association health plans, some of North Carolina’s existing association health plans are worried about what the changes might mean for them.

Several groups, including the N.C. Medical Society, the N.C. Bar Association and the N.C. Bankers Association, filed or signed on to statements addressing the proposed rules.

The Medical Society, whose association health plan covers more than 17,000 employees and dependents across almost 500 medical practices, is worried that some parts of the new federal rules would conflict with the existing federal and state rules it’s governed under.

“The NCMS Trust and other established [multi-employer welfare associations] could be required to make substantial operational and systems modifications that impact our covered employees and dependents,” Steven Sawyer, senior vice president of corporate administration at the N.C. Medical Society Employee Benefit Trust, wrote in comments to the U.S. Department of Labor, which oversees association health plans at the federal level.

Instead, Sawyer said, existing association health plans should be shielded from having to comply with new rules that conflict with current regulations.

Blue Cross and Blue Shield of North Carolina, which administers the Medical Society plan and which is in talks with the Farm Bureau to manage AgCareFirst, also filed public comments. Like the Medical Society, Blue Cross believes that requiring existing association health plans to follow ACA-style rules, where all employers have the same premium levels regardless of the health conditions of their employees, would be disruptive to existing association health plans, which don’t have to follow that rule now.

If Uncle Sam does give association health plans more flexibility in how they set premiums and medical benefits in their plans, they’ll still have to persuade people to sign up for them. And they’ll have to convince doctors and hospitals to take the insurance, which could be a heavy lift.

And if the new federal rules allow association health plans to offer fewer benefits than other health insurance plans, Novant’s Seehausen said, “we’re going to have to be very careful, as a health system, which of these plans we do business with.”

To Curb Rising Health Insurance Costs, Some States Try ‘Reinsurance Pools’

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To Curb Rising Health Insurance Costs, Some States Try ‘Reinsurance Pools’ - North Carolina Health News

Some states' legislatures are experimenting with creative ways to bring down the cost of health insurance for their residents.

By Michael Ollove

Stateline

A couple of years ago, the health insurance exchange in Minnesota – MNsure – was in deep trouble. Health insurance premiums for individual policies had shot up by as much as 67 percent, among the steepest increases in the country.  Insurers were abandoning the market, leaving 116,000 Minnesotans with scant choices.

The Minnesota Legislature offered a solution: a $271 million, publicly funded reinsurance pool that would help health insurance companies pay the most expensive medical claims, thereby lowering overall insurance premiums. The hope was that backstopping the insurers would stabilize the market and halt the rocket-like rise in premiums.

So far, so very good. In its first year, the reinsurance pool has performed even better than expected. According to the Urban Institute, 2018 premiums offered on MNsure not only didn’t increase, they fell by 15 percent.

Minnesota’s peers are paying attention. The Gopher State is one of four states trying to calm roiling health insurance markets by creating state reinsurance pools – even as actions by Congress and the Trump administration continue to create uncertainty in the health insurance industry.

Maryland became the latest to do so when Republican Gov. Larry Hogan last week signed a bill creating a reinsurance pool financed in part in the next year by a $380 million tax on health insurers. Another six states are taking steps to launch their own reinsurance programs.

Reinsurance has long had a place in the private insurance market.

Essentially, it entails insurance companies taking out their own insurance to protect themselves when they are hit by an unexpectedly high claim, “like when somebody needs a heart transplant or a liver transplant or something else where costs are over, say, $100,000,” said Brad Herring, a health economist at the Bloomberg School of Public Health at Johns Hopkins University.

A public health reinsurance plan works the same way, except the state reimburses insurers for claims that climb above a certain set figure, depending on the plan.

In Minnesota’s reinsurance program, health insurers are eligible for reimbursements from the state for claims between $50,000 and $250,000. The insurers are responsible for amounts over $250,000.

Allison O’Toole, MNsure’s chief executive officer, said Minnesota acted in response to soaring premium increases and the departure of insurers such as Blue Cross and Blue Shield, the largest seller of individual policies in Minnesota at the time. No insurers have left the Minnesota market since the reinsurance pool launched.

“We were taking it on the chin. We were really in crisis,” O’Toole said. “This has provided immediate and positive results.”

Alaska, which created a reinsurance pool in 2016, also saw a year-to-year decrease in premiums. A third state, Oregon, authorized the creation of a reinsurance program last fall, but that action came after the premiums had already been set for 2018.

But the fix in Minnesota is temporary. The Legislature ponied up about quarter of a billion dollars for two years, with a roughly equivalent amount expected to come from the federal government. But, O’Toole says, that state support won’t last.

“Minnesota had a significant budget reserve a year ago, so we had money for it,” O’Toole said. “We won’t have that going forward.”

That is why O’Toole and many other state officials want the federal government to help fill state reinsurance pools.

Health policy analysts say the situation has only grown more pressing in recent months.

In December, Congress eliminated the so-called individual mandate as part of the new tax law, meaning that healthy people – who would pay premiums but be unlikely to need expensive care – can now opt out of insurance. And the Trump administration scrapped federal subsidies that were worth about $7 billion a year to insurance companies. Analysts say those actions are likely to lead to higher premiums for those remaining on the individual market and increased financial pressure on insurers.

There were two bipartisan bills in the Senate – one cosponsored by Republican Susan Collins of Maine and Democrat Bill Nelson of Florida, and the other by Republican Lamar Alexander of Tennessee and Democrat Patty Murray of Washington – that would have sent $5 billion a year to the states to finance their reinsurance pools. But neither was incorporated into the spending bill that Trump signed last month.

Avalere, a health policy research firm, estimated that the measure pushed by Collins and Nelson would have reduced 2019 premiums by 4 percent and increased enrollment in Affordable Care Act plans by 180,000. Not surprisingly, the bill had the strong support of the health insurance industry.

Although the Senate bills had considerable bipartisan support, there was significant opposition too. “This bailout approach is wrong and should be abandoned,” a report published last month by the conservative Heritage Foundation said. “It is fiscally imprudent and unnecessary.” It is the ACA’s “radical regulatory overreach,” that has caused chaos in the health insurance market, the report says.

At the same time, many left-leaning analysts say public reinsurance is yet another cumbersome solution to a fractured health care system that should be replaced by a single-payer model.

The Affordable Care Act set up a federal reinsurance pool to compensate insurers for taking on high-risk beneficiaries (who, under ACA provisions, could not be charged higher premiums than anyone else). The law set aside $20 billion, funded largely by a tax on insurers, for the years 2014 through 2016. After that, the pool disappeared, and the determination of congressional Republicans to repeal the ACA made renewal of the program a political impossibility.

States that want to establish their own reinsurance pools with some federal money must apply for a waiver from the U.S. Department of Health and Human Services to depart from some provisions of the ACA while still providing comprehensive, affordable health coverage.

In their applications to create reinsurance pools, states have argued that by reducing premiums, they will save the federal government money because it will have to pay less in tax credits for low-income policyholders.

Alaska created its reinsurance pool with $55 million from a tax on insurers, but it subsequently applied for and received a federal waiver, which is expected to bring in about $58 million in federal money. The state is hoping that because its individual insurance market is so small – about 23,000 people – the federal contribution will negate the need for it to put state money into the pool.

Oregon has committed $1.1 billion in state money, also raised through a tax on insurers, over 10 years and is hoping to receive $356 million in federal money during that period.

In February, Wisconsin enacted a $200 million law that, should the federal government grant a waiver, will funnel $30 million to $50 million in state money into a reinsurance pool with the federal government picking up the rest. Democrats joined Republicans in favor of the bill in both houses. The main opposition came from the progressive group, Citizen Action of Wisconsin, which called the reinsurance plan a bailout for insurance companies.

In Colorado, an early analysis projected that if the state had spent $177 million to create a reinsurance pool in 2018 and received $119 million in federal money, premiums would have declined by 21 percent. Colorado lawmakers are working on a reinsurance pool proposal.

But some financially strapped states simply don’t have the money to set up reinsurance pools. In 2018, Minnesota’s pool will total $271 million: $140 million in state money and $131 million in federal dollars. Minnesota had to provide all the money upfront, and the federal government will pay its share during the course of the year

Not all states can afford to do that, said Sarah Lueck, a senior policy analyst with the Center for Budget and Policy Priorities, a nonpartisan research and policy institute in Washington.

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