Read our Coronavirus Coverage Here

North Carolina Health News

News. Policy. Trends. North Carolina.

Donate Now

Additional Thanks

**Live-tweeting is always a guessing game, and it looks like we spelled Audrey's name wrong. It's actually Audrey Chavous.**

Categories

SCHIP

legislative building in Raleigh

2019 Health & Human Services Budget – House & Senate

by

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.
shows the US Capitol in th rain

A Day on Capitol Hill, Through a Rural Health Lens

by

A Day on Capitol Hill, Through a Rural Health Lens - North Carolina Health News

Against a background of ongoing budget debates in Washington, advocates make the rounds on Capitol Hill, looking for support for rural health centers and hospitals.

By Taylor Knopf

It was a cold, wet, windy day as rural health advocates from North Carolina walked toward Capitol Hill earlier this month.

They had back-to-back meetings in the offices of six N.C. congressmen: Sens. Thom Tillis (R) and Richard Burr (R), and Reps. David Price (D), G.K. Butterfield (D), Alma Adams (D) and George Holding (R).

The group was in Washington D.C. for the annual National Rural Health Association conference, where the discussion centered around the health disparities and crumbling financial landscape in rural America. Few discussions about rural health ended without mention of opioid addiction and overdoses, and the ever-improving resource of telemedicine.

shows a group of advocates with a congressional representative.
The North Carolina rural health group only got a quick photo-op with Rep. David Price, the only lawmaker they saw in his office that day. Left to Right: Jeff Spade, NC Healthcare Association Deborah Owens, Foundation for Health Leadership & Innovation-NCRHLA David Tillman, Campbell University Anne Thomas, Foundation for Health Leadership & Innovation Representative David Price Laurel Molloy, UNC Healthcare-Lenoir Hospital Joy Williams, rural advocate Jay Kennedy, The Duke Endowment Laura Jane Ward, Foundation for Health Leadership & Innovation-NCRHLA. Photo credit: Taylor Knopf

Every day on the Hill is advocacy day for some group or another. As the rural advocates wandered through the halls of Congressional office buildings, another group of blue-collared men wearing “save our pension” buttons passed by.

The rural health group from North Carolina was shepherded from one Congressional conference room to another (or rooms that were more nook between room dividers for some of the minority party representatives).

Meanwhile, each office television live-streamed the proceedings from the floor of the House of Representatives where Nancy Pelosi was giving a filibuster-style speech on the preservation of Deferred Action for Childhood Arrivals or DACA.

But most legislative aides were more concerned with what the latest budget agreement would hold.

By the time the group was on a plane headed back to North Carolina, the final spending deal included 10 years of funding for the Children’s Health Insurance Program (CHIP), money for community health centers, and $6 billion over two years for opioid addiction treatment and overdoses.

These are all big wins for the rural health community. At the same time, the budget for the Centers for Disease Control and Prevention was cut by 20 percent.

Sponsored

“As we met with harried, overworked staff and Congressmen during a budget negotiation that included funding for community health centers and CHIP, I was struck all over again [by] the extent to which advocacy matters,” said Deborah Owens with the Cary-based Foundation for Health Leadership & Innovation and a longtime rural health advocate.

The plight of a small rural hospital

For Laurel Molloy, it was her first time advocating on the Hill. Molloy is the chief nursing officer and vice president of Lenoir UNC Health Care, a hospital in Kinston. She came to explain to the state’s congressmen (or to their legislative assistants) just how difficult it can be to run a rural hospital.

There is high poverty and a disproportionately high share of patients who only have Medicare or Medicaid in the population around Kinston.

A young woman sits at the head of the table explaining policy to three people who are older and more experienced than she is.
Rachel Soclof (l), health policy assistant to Sen. Richard Burr explains the opioid discussions happening on the Hill with (r to l) Jeff Spade from the NC Healthcare Association, Anne Thomas, from the Foundation for Health Leadership & Innovation and Jay Kennedy, from The Duke Endowment. Photo credit: Taylor Knopf

“The challenges are really socio-economic, and we are required to meet the same standards of care, but I can say it’s very challenging,” Molloy told Rachel Soclof, Burr’s health policy assistant. “We have operated at a negative margin for many years and the model of payment is really not sustainable.”

Molloy explained that the hospital reached a “crossroads” about five years ago when hospital leadership was told it needed to partner with UNC.

“But there are still lots of other things that affect that partnership in terms of growth than just the health and wellness of the community,” she explained.

“I think we rank 88th out of the 100 counties in terms of health outcomes, which is dreadful. That’s a very high disease burden. Even from Medicare, we have a really high percentage of those who are dual eligible [also eligible for Medicaid because of their low income]. We are really talking about a needy population.”

In addition to patients and community health outcomes, Molloy worries about her staff.

“But I feel like in my role as a senior leader that I also have a duty to the folks working in the hospital,” she said. “We offer higher wage employment. We are part of the health and wellness that is there.”

shows a younger man taking notes as an older man and woman speak.
Laurel Molloy, CNO of Lenoir UNC Health Care explains the plight of rural hospitals to Dennis Sills (on the left), senior legislative assistant to G.K. Butterfield. Photo credit: Taylor Knopf

There are people who have worked at that hospital their whole lives and don’t know anything else.

“I’m in a position right now, as well as other senior team leaders, where we are talking about cuts again. Not huge, but the idea that we are losing money and have a negative margin year after year. It’s not sustainable,” Molloy said. “Not that I want anyone to lose their job, I really don’t. But we have to figure out how to do this differently.

“I don’t want folks to ever feel like the mainstay of the city, the hospital, that it would ever be in jeopardy,” she added.

What to do about the opioid problem

When talking about mental health needs in her community, Molloy segued right into the problem of opioid addiction.

“We are in distress,” she said. “I can tell you that just in our little emergency department, we often hold the sickest of the sick. So, patients that have serious mental illness, they have medical comorbidities, they have a propensity for violence. That’s a huge issue. These folks that are the most vulnerable are stuck in our emergency department for a long time waiting for a bed at Cherry [one of the state’s inpatient psychiatric facilities.]

“The point is that opioids can’t be discussed without looking at those economic drivers and without looking at what’s happened to mental health across the state,” Molloy said, adding that the state’s behavioral health management companies haven’t worked well in her community.

older man speaks with a younger woman
Deborah Owens, from the Cary-based Foundation for Health Leadership & Innovation-NCRHLA talks to U.S. Rep. David Price about rural health care and the need for Medicaid expansion. Photo credit: Taylor Knopf

Soclof, Burr’s aide, said the multi-faceted issues surrounding opioid abuse and overdoses have consumed every committee in Congress.

“So part of all these hearings is to get a grasp of the issue before us,” she said.  “Where can we most effectively target a response?

“That’s also part of why some legislation is taking time to come out, just trying to figure out the most effective way possible,” Soclof said.

She added that a lot of money has been thrown at the problem, through the 21st Century Cures Act and others.

“We don’t want to throw more money at a problem that we are not seeing an improvement on. So we’re trying to really understand what’s currently happening,” she concluded.

Influence in real time

Over the past few years, the National Rural Health Association’s annual conference in D.C. has focused a lot on the best ways to implement and preserve the Affordable Care Act, said Maggie Elehwany, NRHA’s vice president of government affairs and policy.

While that’s still a priority, as well as expanding Medicaid in states that haven’t done so, Elehwany said it’s finally time to stop playing defense and go on offense.

shows a group of people standing in the rain outside of a doorway where there's a metal detector.
The rural health group stands in the rain waiting to go through the security line at a Congressional office building. Photo credit: Taylor Knopf

“[We want to] show the government these growing disparities,” she said. “If you want to try to address this, there is one kind of common denominator and that is the economic plight in rural America… That’s why we really try to focus on an offense message as we debate the infrastructure bill and what’s going to be a part of that.

“If you want to fix what’s broken in rural America, we can start from understanding that health care is part of infrastructure. That’s the theme. If you can have a healthy economic community, you can have a healthy population in rural America and vice versa,” Elehwany said.

The North Carolina state legislature has also heard some of the same arguments during its recently established rural health committee.

Jeff Spade, vice president of the NC Healthcare Association, was pleased the group from North Carolina could arrange visits with congressional leaders, calling the relationships “invaluable.”

“It was exciting to be on Capitol Hill while significant debate was occurring on the federal budget,” he said. “Many of the rural health issues and concepts that we discussed with our delegation were being actively considered in the budget process, both in the Senate and House.

“We had a remarkable ability to inform our legislative aides and congressional leaders as they were actually considering important rural health legislation, such as funding for [community health centers] and extending important rural health legislation, for instance, …  CHIP funding, opioid crisis funding, and reversing Medicaid [disproportionate share hospital] cuts,” Spade said.

shows a little boy sitting on an exam table in a physician's office, backlit by the window

Child Health Advocates Put a Brave Face on It, But Worry About Congress’ Inaction on CHIP

by

Child Health Advocates Put a Brave Face on It, But Worry About Congress’ Inaction on CHIP - North Carolina Health News

The deadline to re-fund the program that insures about a third of the nation’s children has come and gone, but there’s still not money for SCHIP.

By Rose Hoban

More than 200,000 children in North Carolina receive health care via the federally funded State Children’s Health Insurance Program or SCHIP, a program that dates back to the Clinton administration and which has traditionally had bipartisan support.

Except for this year.

A deadline passed on Sept. 30 for Congress to reauthorize the program, which provides health care for more than 35 million children nationwide. But lawmakers, distracted by other priorities and horse-trading over repeal of the Affordable Care Act and tax reform, allowed the deadline to skate on by.

bar graph showing that more than half of Medicaid enrollees nationwide are children/ CHIP recipients
Medicaid Child and CHIP Total Enrollment in August 2017: Individuals enrolled in the Children’s Health Insurance Program (CHIP) and children enrolled in the Medicaid program as compared to the number of adults enrolled in the Medicaid program. Data, graphic courtesy: U.S. DHHS

Six weeks later, there’s still no reauthorization for the program and advocates for children’s health are staying optimistic, while privately sweating over what could happen next.

North Carolina’s Health and Human Services Sec. Mandy Cohen said this week that she’s had multiple conversations with the state’s Congressional delegation.

“They’re very well aware that this is a must-do, must-pass,” she said.

But that hasn’t yet translated into action, in part because most states, including North Carolina, run out of SCHIP money early next year.

“We’ve had a cushion so they’ve taken advantage of that cushion,” she said. “But that cushion is about to run out.”

headshot of Cohen
Mandy Cohen, MD Photo courtesy: NC DHHS

Cohen said that there’s no hard and fast “drop dead date” but that the pain would come in phases.

“I think January is going to be when we start to make some hard decisions and at least start notifying people that hard decisions could come,” Cohen said. Those hard decisions would include freezing enrollment, then notifying families with slightly higher incomes and healthier kids that their insurance may lapse.

Caught between chambers

There are about 938,000 kids covered by Medicaid in North Carolina, those are kids in families who make less than $32,718 per year (in a family of four).

But North Carolina has always covered kids whose families make too much for them to qualify for Medicaid. There are about 200,000 of those kids living in low-income families with incomes up to 200 percent of the poverty level ($49,200 for a family of four) who are eligible for the SCHIP, which in North Carolina is called Health Choice.

Their benefits are not as robust as for kids who qualify for children’s Medicaid. For instance, there are some copays for parents. But the prices are low enough that these kids get the essentials needed for a child to grow up healthy.

pie chart showing 47 percent of children covered under employer-sponsored insurance, 36 percent covered by CHIP and the rest by self-paid insurance or other, with 5 percent uninsured
Source: American Academy of Pediatrics

Cohen noted some kids in the higher income families could go to the individual insurance market, but there are other kids that the state is obligated to continuing covering. That would mean difficult tradeoffs.

Earlier this month, the U.S. House of Representatives has passed a bill to fund the program, but the significant cuts made to pay for it raised objections from Democrats. The bill bumps up premiums on wealthier Medicare beneficiaries, cuts $6.35 billion from the Prevention and Public Health Fund created under the Affordable Care Act, and shortens the grace period for people who buy insurance under the Affordable Care Act who fail to make premium payments from 90 days to 30 days.

The bill is stuck in the U.S. Senate, where lawmakers differ with House members over how to pay for the program. Instead of offsets, the Senate version would phase out a reimbursement increase that the House version has put in place.

“Everyone understands that it’s an important process that will get there, but timing is a problem,” said state Sen. Ralph Hise, who co-chairs the Joint Legislative Committee on Health and Human Services at the General Assembly.

“A lot of people I’ve talked to particularly in the Senate are frustrated at the inability to get anything to move,” Hise said. “I’m anxious to move ahead with the final funding and get this off the table… But like everyone else in the state, I’m frustrated Congress isn’t doing anything.”

Elizabeth Hudgins from the Pediatric Society said she’s trying to stay optimistic.

“We’re appreciative of the priority that both the House and the Senate are placing on it,” Hudgins said. “But we’re very concerned that as it moves forward there not be harmful offsets, that you need to look at child, family and community health altogether.”

Frustrated docs, parents

Right now, the Twitter feed of the North Carolina Pediatric Society is filled with stories of SCHIP children, written by their parents.

“The kids are able to get well -child check-ups, and I have two asthmatics in my home who need equipment and regular inhalers, as well as prescriptions,” reads one, written by a mother named Afisa, in Raleigh. “I am married to a veteran and only he is qualified to receive his insurance. It’s very expensive for a family of six with only one low-income job that offers insurance to its employees.”

And pediatricians are weighing in too, anxious because the state has the lowest rate of uninsured children, 4.4 percent, since the state started keeping track, and they’d like to see that continue.

“I don’t even want to think about what children’s health without CHIP health would look like,” tweeted Chapel Hill pediatrician Eliana Perrin.

“Improvements in children’s health insurance are closely tied to Medicaid, Health Choice, and the ACA, so policy or administrative changes to these programs at the state or federal level could diminish or eliminate recent gains in coverage,” noted the North Carolina Institute of Medicine earlier this year in its annual child health report card.

Cohen said that if Congress doesn’t act by January, the General Assembly has some options.

“They have a rainy day fund for times when things are hard, so you could imagine a time when… we might have to talk that through,” she said. She said that for now, she’s taking it “one month at a time,” but that January is when the hard conversations would begin.

“I think March is more the timeframe when the other shoe would drop,” Cohen said.

[email]
[email]
[zip]
[zip]
[listGroups]
[listGroups]
[email]
[email]
[zip]
[zip]
[listGroups]
[listGroups]