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shows three politicians who are usually at odds on the same dias, they're there in order to sign bills to provide COVID relief

State Senate presents budget, with a bump up in spending for health and human services

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State Senate presents budget, with a bump up in spending for health and human services - North Carolina Health News

The budget proposal expands Medicaid coverage for postpartum women, but leaves many other uninsured North Carolinians behind.

By Greg Barnes, Anne Blythe, Mona Dougani, Rose Hoban

In a much-delayed and much-anticipated bill, the state Senate presented their proposed biennial budget on Monday that includes billions of dollars to shift North Carolina’s Medicaid system from one run by the state to a new apparatus largely run by private managed-care insurance organizations. 

“Our nonpartisan fiscal analyst told us that we had an even bigger surplus than we initially thought,” Senate leader Phil Berger, an Eden Republican, said during a press briefing Monday before releasing the spending plan. “The Senate is proposing to reduce taxes even more and advance a 10-year $12 billion cash infrastructure and capital plan that includes $3 billion in cash over the next two years for projects.”

The $25.7 billion proposal would reduce tax rates for individuals and families, as well as phase out the corporate income tax in North Carolina. State coffers are temporarily overflowing with billions in federal coronavirus relief spending, courtesy of the American Rescue Plan, a $1.9 trillion bill passed by the U.S. Congress and signed into law by President Joe Biden in March.

Despite federal incentives, the Republican-majority legislative body defied Democratic Gov. Roy Cooper once again, refusing to fund one of his long-held priorities, namely expanding the state’s Medicaid program to sweep in more than a half-million uninsured state residents who are mostly low-income workers.

“The offer from the feds is additional one-time funds,” responded Sen. Ralph Hise (R-Spruce Pine) when asked about why there was no expansion during a press conference Monday afternoon. “We’ve made the same arguments about not expanding Medicaid for a lot of years now.

“We felt very important that our real focus instead of just finding general population to expand to was to focus on those of the greatest need.”

“For no additional state tax dollars, we can expand Medicaid which would insure more than half a million working people, reduce businesses private insurance premiums, expand mental health services, help save rural hospitals and create thousands of new jobs,” retorted Mary Scott Winstead, from Cooper’s office in an email. “Republican leaders have told the Governor that Medicaid Expansion is still on the table for negotiations even though they have not included it in their own budgets.”

The Senate proposal does extend Medicaid benefits for low-income pregnant women. Currently, their Medicaid benefits expire 60 days after they’ve given birth, but the American Rescue Plan allows for states to extend those benefits for a year, with the program beginning in April 2022 and available to states for five years. According to the Kaiser Family Foundation, this could result in fewer uninsured low-income mothers.

“Many of the conditions that account for a significant share of pregnancy-related mortality and morbidity, such as cardiovascular diseases, hypertension, and depression often require care over a longer-term,” a KFF review states. 

The budget also would add 1,000 slots for people with disabilities to receive enhanced community services under the Innovations Waiver, which has a current 10-year waiting list of more than 15,000 people. The spending plan also allows for people who have children in the foster care system to retain their Medicaid benefits, so long as they’re in a treatment program or “making reasonable efforts to comply with a court-ordered plan of reunification” that would eventually return them to their children. 

Increased wages for direct care workers

The proposed Senate budget includes bumping wages to $15 an hour only for the state employees working in intermediate care facilities that serve individuals with mental health and intellectual disabilities. 

Other direct care workers not employed by the state of North Carolina would receive a one-time bonus of $1,500 if employed by eligible providers who are enrolled in the Medicaid or North Carolina Health Choice program.

Rep. Tim Moffit (R-Hendersonville) supported HB 665, the Address Direct Sup. Staffing Crisis/Medicaid bill, and who championed HB 914, a measure to provide boosted Medicaid reimbursement for non-state agencies providing care for people with disabilities. He said he did not have any opinion on the proposed Senate budget yet.

“Their budget was released last night, and I’ve not had a chance to review their budget,” Moffit said. “I’m not sure what they’re providing for in their budget… I really don’t have any comment regarding that.”

Currently in North Carolina, the average hourly wage for direct care workers is $10.31/hour making it difficult for facilities to hire and retain staff. 

In the proposed budget, senators insisted that 80 percent of the direct care worker increase be allocated to those workers’ salaries. The remaining 20 percent of funds could go to supervisor salary, pensions, health benefits, facility maintenance and more. 

Some advocates worry that this could cause wage compression, resulting in supervisors and direct care workers receiving similar wages. 

“If you raise the hourly wage of the worker, what about the supervisor,” said Rep. Gale Adcock (D-Cary), a nurse practitioner. “Then you lose your most experienced supervisory staff.”

“Those of us who don’t provide this, these services, and deal with this business model shouldn’t be the ones telling the people who do it, how to do it.”

A total of $17,500,000 will be used to provide the rate increase for state direct care workers for the 2022-2023 fiscal year. 

Money to improve school buildings

The senate’s proposed budget would allocate $150 million in one-time funding to test and remove lead found in excessive concentrations in public schools and child care centers. Removal of asbestos from the schools and child care facilities would also be part of the appropriation.

“Right now there’s no funding for schools to do testing and mitigation for lead in drinking water. It would be an enormous support to allow schools to get the testing that they need and then also pay for mitigation,” said Jennifer Hoponick Redmon, a senior environmental health scientist and chemical risk assessment specialist with RTI International in Research Triangle Park.

RTI, along with the state’s Division of Public Health, have now tested nearly all of the licensed child care centers in North Carolina for lead in drinking water. Hoponick Redmon said 9 percent of the 3,000 centers and Head Start programs tested had lead levels exceeding the 15 parts per billion threshold the U.S. Environmental Protection Agency considers safe to drink.

In 2019, the Charlotte-Mecklenburg school system tested for lead in water used for drinking and cooking at its schools. The testing found that 41 of 89 schools had taps exceeding the EPA’s lead limit of 15 parts per billion.

The testing is being done largely through an EPA grant. Researchers are advising centers on how to remove the lead from their faucets, but it is up to the centers to take remedial action, Hoponick Redmon said.

The EPA has not provided funding to test for lead in public schools, but researchers know the contaminant is present in some of them, especially in schools built before a federal law approved in 1986 banned lead use in pipes and fittings.

Under the Senate’s budget proposal, $32.8 million of the $150 million would be used for lead testing and remediation. The budget bill creates a mechanism to provide funding to replace lines, pipes and fixtures found to contain the heavy metal.

Children are especially vulnerable to high lead concentrations. Exposure can damage their nervous systems and cause learning disabilities, stunted growth, hearing loss, low IQ, increased aggression, and impaired formation and function of blood cells.

Asbestos, a known carcinogen, has also become a growing concern, especially in older schools. It can be found in construction materials behind walls, above ceilings and under floors. Asbestos becomes a problem when its fibers come loose and can be inhaled.

According to the EPA, asbestos fibers can cause serious health problems. If inhaled, they can disrupt the normal functioning of the lungs. Three specific diseases – asbestosis, lung cancer, and another cancer known as mesothelioma – have been linked to asbestos exposure. A federal study in 2015 found that two-thirds of more than 5,000 schools tested contained asbestos.

The remaining $117.2 million of the appropriation would be used to fund a program for lead paint abatement and asbestos removal in the schools and child care centers.

Beyond child care pandemic woes

Child care centers were hit hard during the pandemic, highlighting an industry that’s crucial to keeping the economy churning while also exposing this necessary societal infrastructure that often lacks the support it needs from state and federal governments.

Many centers operate on very thin margins, trying to keep costs for parents as low as possible while also working to bring in enough money to attract a faithful and helpful workforce.

Such a financial model means many centers in North Carolina can only offer staff $10 to $13 an hour, a wage that can’t compete with what some fast food restaurants and other jobs offer.

The Senate spending proposal makes a nod to the issue, albeit a slight one, according to early childhood education advocates.

The plan proposes to put $1.7 million in each of the two fiscal years to increase base reimbursement rates for child care centers participating in the state Department of Health and Human Services North Carolina Prekindergarten Program by 2 percent from last year’s rates and an additional 2 percent next fiscal year.

The intent, according to the Senate bill, is for the additional funds to “be used to increase the salaries of teachers working in child care centers as a means to address disparities in teacher salaries among teachers working in child care centers versus those working in public schools or Head Start centers.”

“I think it’s a good step forward,” Michelle Rivest, senior campaign director for the North Carolina Early Education Coalition, said on Tuesday. “It’s a good step, a small step forward in recognition, that we don’t have equity in pay for public or private early childhood educators.”

She pointed out, though, that “$1.7 million won’t go far.”

The Senate plan includes some $20 million for start-up grants for NC pre-K classrooms and child care centers across the state after it was exposed recently that some 30 counties did not have the infrastructure to expand Pre-K programs.

Rivest also was happy to see that Smart Start, an early childhood education program, would receive $15 million in one-time state funds. 

“It really is an important step forward for Smart Start,” Rivest added.

Many advocates for an early childhood education program relied on by more than 60 percent of North Carolina families have been pushing for a broader discussion on government subsidies.

They were optimistic that such talk might materialize after the administration of President Joe Biden announced in April that $39 billion in federal aid coming to states should be used to “address the child care crisis caused by COVID-19.” North Carolina’s share was $1.3 billion.

Some of that federal money was included in the Senate’s proposed spending plan to help stabilize the child care industry. The question is what happens after that money is not available.

Other proposed budget appropriations: 

  • $15 million for research into PFAS and a dozen new positions at the state Department of Environmental Quality for research into emerging compounds such as GenX. 
  • $30 million to fund the legislature’s GREAT program, as well as $700 million in federal dollars to improve rural broadband.
  • $1 billion in federal American Rescue Plan spending on water and sewer grants to local governments
  • $250,000 in the next fiscal year only for grants to schools for feminine hygiene products for students.
  • $30 million to the North Carolina Policy Collaboratory for COVID research grants, including up to $18 million to the Rapidly Emerging Antiviral Drug Development Initiative at the University of North Carolina at Chapel Hill.
  • $5.9 million over the two-year period to the residency program at the East Carolina University Brody School of Medicine.
  • $7 million to Wake Forest Institute for Regenerative Medicine for a research project to accelerate the development of treatment to harmful chemical and biological agents.
legislative building in Raleigh

2019 Health & Human Services Budget – House & Senate

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

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

By Rose Hoban

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

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

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

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

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

HOUSE

SENATE

Division of Central Management and Support

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

Division of Child Development and Early Education

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

Division of Health Benefits

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

Division of Health Service Regulation

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

Division of Public Health

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

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

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

Division of Social Services

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

Division of Vocational Rehabilitation Services

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

FINAL – 2018 Health & Human Services Budget

by

FINAL – 2018 Health & Human Services Budget - North Carolina Health News

This year's budget featured an unusual process, and millions in earmarks for constituents back home.

By Rose Hoban and Jared Weber

In years past, North Carolina Health News has published a table tracking the progress of the state budget as it makes its way through the General Assembly, first in one chamber, then to the other and finally, to the negotiated conference budget in the third column. This has happened in the long legislative work sessions (odd-numbered years), when lawmakers hashed out the biennial state budget and also in the short session (even-numbered years), when legislators returned to Raleigh to update the budget for the second year.

But this year’s budget process at the General Assembly was a radical departure from prior years. Instead of each chamber presenting its ideas for spending and then hashing it out, with lobbyists and advocates all asking for their piece of the pie, lawmakers from the Senate and the House of Representatives negotiated the budget for the second year of the biennium out of sight. Then legislators used a parliamentary procedure colloquially known as “gut and amend,” where they stripped the prior language out of one bill which had already been through committee hearings and votes in each chamber and dropped in the entire 266-page budget.

Thus, an innocuous bill about insurance regulations morphed into the state’s FY 2018-19 budget.

Because there are no prior versions to compare to, instead, we have compared this year’s final budget (right-hand column) to the final adopted 2017-19 budget created last year (left-hand column).

The FY 2018-19 budget also departed from prior budgets in another, significant way – the extraordinary amount of earmarks, i.e. special, one-time funds given to the folks back home. Those special funds, also known as “pork” or “bringing home the bacon,” were largely absent from the state budget after Republicans took control of the General Assembly in 2010. But earmarks made their reappearance in the 2017 budget, and this year’s bill is rife with one-time spending back home during a tough election cycle. They number in the dozens of appropriations, ranging from $7,500 to a food pantry in Mt. Olive to $750,000 to a children’s center in Surry County totaled more than $5.9 million of spending added to the Health and Human Services budget alone, not to mention throughout the rest of the budget.

These earmarks are marked in dark blue text, while last year’s earmarks are noted in dark red text. We’ve included links to stories which flesh out some of the programs contained in the budget.

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!

Final – as of June 2017

Final as of June 2018

CENTRAL MANAGEMENT AND SUPPORT

CENTRAL MANAGEMENT AND SUPPORT
Orders the Department of Health and Human Services to cooperate with the state Chief Information Officer to coordinate all health information technologies policies and programs in the state. Goals include protection of health information privacy, use of electronic health records to improve patient health care coordination, coordination of the health information exchange, facilitation of research, early detection of outbreaks, etc. Technical changes to DIT statute.
Cuts $3.2 million in one-time funding each year for contracted services. Reductions are not to be taken from any contracts/agreements that are providing direct services or supporting the US DOJ Settlement/Transitions to Community Living Initiative. Total appropriation is $24.24M, based on $100.6M total requirement, Senate’s total appropriation was $32.7M based on $152M in required funds. Prohibits DHHS’ management from using any salary reserve to create new staff positions or to increase the salary of existing jobs until the Division of Central Management and Support hires a director and staff to fulfill OPERA duties (detailed in 2017 budget, line 52).
Orders DHHS to cooperate with the state Department of Information Technology to create standards compatable with national standards, develop a state plan for compliance with federal IT standards, and incorporate data about patients who are aged, have behavioral health issues, and other underserved populations into state and national databases.
Orders the Division of Central Management and Support to continue implementing the Child Welfare ASSIST program established in 2014; orders DHHS to execute any required interagency agreements by October 2018. Appropriates $250,000 in recurring funding, $1M in one-time funding, for a total of $1.25M for the 2019 Fiscal year.
Appropriates an additional $200,000 in one-time funding each year for the Medication Assistance Program that provides assistance for people who are uninsured or underinsured and helps them obtain charity drugs from manufacturers.
Earmarks $386,667 in receipts to match federal funds for enhancing Medicaid Management Info System standards and allows for the creation of 10 positions dedicated to the project.
Directs $3,480,000 in new funds over the biennium for the IT projects above. Adds $1.5M to 2018-19 budget for information system services. $1.25M is for Child Welfare ASSIST program (see also line 6), $250,000 for enhancements to NC FAST to do better asset and income verification.
Directs $350,000 from the federal Social Services Block Grant to be used specifically for the Big Brothers/Big Sisters program. This means the Social Services Block Grant has a total of $4.2 million for all other competitive grants. Provides $50,000 in one-time funding for Second Harvest Foodbank of Northwest NC a Winston-Salem nonprofit to combat hunger. District represented by Rep. E Terry, Sen. P Lowe
Provides $200,000 in one-time funding for Big Brothers, Big Sisters of Central Carolinas to support the Big Day at the Lake program. Agency located in district represented by Rep. Autry, Sen J Jackson Provides $500,000 in one-time funding for NeighborHealth Center, Inc., a Christian-based clinic that provides services to the growing number of people in Wake County who lack access to healthcare. Agency located in district represented by Rep. G Martin, Sen. J Chaudhuri
Provides $50,000 in one-time funding for Boys and Girls Clubs of Wilmington. Agency located in district represented by Sen. M Lee, Rep. Deb Butler. Provides $50,000 in one-time funding for Hands of Hope Medical Clinic, a Yadkinville clinic that offers free medical care for uninsured patients. District represented by Rep. L Zachary, Sen. J Krawiec
Provides $37,080 in one-time funding for Boys and Girls Clubs of Central Carolina (Sanford). Agency located in district respresented by Rep. R Reives, Sen. R. Rabin Provides $35,000 in one-time funding for Give Kids a Smile, an ADA dental foundation program for free oral health care.
Provides $20,000 in one-time funding for Boys and Girls Clubs of Greene County. Agency located in district respresented by Rep. G Graham, Sen. D Davis Provides $25,000 in one-time funding for HealthQuest a free pharmacy located in Union County, to provide free prescription medicine to low-income and indigent persons. Agency located in district represented byRep. D Arp, Sen. T Tucker
Provides $50,000 in one-time funding for the Hands of Hope Medical Clinic in Yadkinville. Located in district represended by Rep. L Zachary, Sen. Joyce Krawiec Provides $30,000 in one-time funding for Wayne Action Team for Community Health (WATCH), a free clinic for uninsured Wayne County residents. District represented by Rep. L Bell, Sen, D Davis
Provides $125,000 in one-time funding to the Community Free Clinic. Located in district represented by Rep. L Johnson, Sen. P Newton Provides $25,000 in one-time funding for Ada Jenkins Center a community center that also to provide safety-net healthcare services and food assistance in Davidson County. District represented by Rep. J Bradford, Sen. J Tarte
Provides $250,000 in one-time funding to the James Austin Health Center. Located in Rockingham County, represented by Rep. B Jones and Sen. P Berger Provides $250,000 in one-time funding for Free Clinic of Reidsville, provides care for uninsured Rockingham County residents. District respresented by Rep. K Hall, Sen. P Berger
Provides $600,000 in one-time funding for C.W. Williams Community Health Center, a federally funded health care center that provides services to people of Mecklenburg, to provide for building repairs and upgrades. District represented by Rep. B Carney, Sen. J Ford
Provides $100,000 in one-time funding for Onslow Community Ministries Inc, a basic service provider for the most vulnerable people of Onslow County, funding for renovation of the agency’s soup kitchen. District represented by Rep. P Shepard, Sen. H Brown
Provides $7,500 in one-time funding for Make a Difference Food Pantry in Mount Olive pantry. District represented by Rep. J Dixon, Sen. Louis Pate
Provides $25,000 in one-time funding for Loaves and Fishes of Union County, a nonprofit, volunteer community food pantry located in Monroe. District represented by Rep. C Horn, Sen. T Tucker
Provides $50,000 in one-time funding for Backpack Ministry, Inc, an organization that partners with elementary schools to provide low-income children with meals. Many locations statewide.
Allots $20 million in one-time funding and $11.9 million in earned revenue for the creation of software to track child services case management that will be integrated into the NC FAST system. Allots $179 million over two years in DHHS federal receipts to make the NC FAST child welfare case management system happen.
Sets aside an additional $1.6 million annually from the federal Substance Abuse Prevention and Treatment Block Grant specifically for Durham’s TROSA, a substance abuse treatment program. TROSA receives $3.2 million from this block grant each year. Sets aside $6 million for Durham’s TROSA to be used as grant-in-aid for the organization to develop a second facility in the Piedmont Triad. This is in addition to last year’s appropriation of $1.6 million to pay for treatment.
Appropriates $1.9 million in annual funds and 32 positions in FY 17-18 and $7.7 million in annual funds and 54 positions in FY 18-19 to provide ongoing maintenance for NC FAST. Over the two years, $25.5 million in departmental receipts are to be directed toward this work. Provides additional $59,459 in state dollars and federal matching dollars to fund 2 positions for employees to create training and certification program for caseworkers who use NC FAST. Allows for these staff to be hired in the beginning of Feb, 2019.
Cuts $7.7 million in the annual appropriation to Cape Fear Valley Medical Center to cover the costs of graduate medical education, while adding a one-time appropriation of up to $3 million. Why? In the last budget cycle, this money was appropriated to offset losses to CFVMC due to its redesignatation from an urban center to a rural one by CMS. But *new* changes in CMS policy means CFVMC will regain it’s urban hospital designation at the beginning of the federal fiscal year in October.
Orders DHHS to continue working with the Goverment Data Analytics pilot program, initiated in 2015, to get Medicaid analytics to generate information about population health, to optimize health care savings and efficiencies, and to create better health outcomes. Requires DHHS to comply with policies established in GS 143B-1385 Government Data Analytics Center statute.
Appoints $8.9 million in FY 17-18 and $11.1 million in FY 18-19 to create new functions in the NC FAST computer system that helps it meet new federal requirements around privacy and fraud detection. Allows for the personnel costs of four people in each year.
Also allocates $1.9 million and 32 workers in continued funding in FY 17-18 and $7.7 million in continued funding and 54 workers in FY 18-19 for continued operations of NC FAST, the DHHS system for signing beneficiaries up for services. New projects are coming online include fraud detection (program integrity), Child Care Subsidy tracking and energy assistance programs. Reduces by $181,202 in Low Income Home Energy Assistance Program Block Grant funds that were to be used for the development of integrated case management component noted in 2017 budget.
Moves $8.5 million from the Low Income Heating Energy Assistance Program Block Grant funds to the LIEAP program. No effect on the General Fund.
Updates existing statutes around the state’s designated health information exchange that was created in 2015. The HIE aggregates and collects clinical and demographic data from hospitals, physicians, and other providers and the managed care organizations (prepaid health plans) that will be running Medicaid once the system changes from fee-for-service payment to managed care. Right now, MCOs only need to submit claims data. Providers are required to make a technical connection to the HIE to submit clinical and demographic patient data for all state funded / Medicaid services.
Hospitals were required in an earlier statute to connect to the HIE, this clarifies the language and expands to other providers, requiring them to connect in order to be paid for any state funded / health services provided. Proposes a study by Department of Information Technology, State Health Plan and DHHS to better understand what data other types of providers collect and whether they have value for the HIE. Proposes a study to look at providers who currently don’t collect clinical data, and see what’s really needed. Providers of Medicaid services who have electronic records must connect by June 2018, LME-MCOs must connect by June 2019.
Allows for DIT and DHHS to create a process for providers who are having trouble connecting to the HIE network to allow them to delay connection. Agencies requesting delay must make a presentation to DIT, DHHS about why they are delayed in connecting and expected timeline. Mandates that all connections be made by drop dead date of June, 2020. Requires providers to add patient demographic, clinical and data to the HIE network two times a day.
Consistent with federal rules, exempts any disclosure of drug or alcohol abuse history with patient identifying information from the HIE.
Continues the right for a person to opt out of having their information accessible through the HIE, changes statute around opt out capability for emergency services, which no longer applies.
Orders DHHS and DIT to conduct a feasibility study to look at connecting providers and submitting encounter and claims generated in the State Health Plan for State Employees to the HIE, and stipulates what topics need to be addressed in the study. Report due to the DHHS, DIT and the state Treasurer’s office to legislative committees. To be completed by April 2018.
Requires LME-MCOs to comply with the data submission rules created in the budget.
Orders DHHS to transfer $3 million in one-time funds and $1 million in annual funds to the Department of IT, Government Data Analytics Center to upgrade and support the maintenance and operations of the HIE.
Orders DHHS and DIT to conduct a feasibility study to look at connecting providers and submitting encounter and claims generated in the State Health Plan for State Employees to the HIE, and stipulates what topics need to be addressed in the study. Report due to the DHHS, DIT and the state Treasurer’s office to legislative committees. To be completed by April 2018.
Appropriates $250,000 in one-time funding to help DHHS information technology workers to improve security, including the removal of people’s Social Security numbers from the system and replacing them with a unique ID number. This is a federal requirement set out by the Centers for Medicare and Medicaid Services and is required, by law, to be completed by April, 2019.
Provides $844,412 in recurring funding through the biennium and $630,000 in one-time funding through the biennium for six contract IT workers to support the implementation and training for several new computer programs, such as HIV care database. Makes allowance for six positions.
Orders DHHS to spend $1.2 million annually develop and launch better analytics for the Controlled Substances Reporting System. This includes creating the ability for the CSRS to talk to the NC HIE (see above), creating analytics to detect “behavior indicative of misuse, addiction or criminal activity,” including unusual prescribing patterns, and help providers improve prescribing practices.
Orders that any data analytics upgrades be written and implemented in collaboration with the Government Data Analytics Center.
Budgets $3.6 million in federal monies in FY 17-18 and $4.8 million in federal monies in FY 18-19 to replace the old case management computer programs used by several DHHS divisions, such as Services for the Blind. The money will also help get up and running with submitting invoices and getting paid online. Moves $85,924 in Social Services Block Grant federal funding into the Division of Services for the Blind.
Budgets $100,922 in FY 17-18 and $159,713 in FY 18-19 to improve counties’ ability to record and submit forms for federal and state reimbursement.
Changes the DHHS Community Health Center grant program, limiting grants to community and rural health centers, local health departments, and school-based health centers that 1) provide primary and preventive services to medically indigent and uninsured populations, and 2) are intended to increase access to primary and preventive care services, including such things as creating new services or replacing facilities and equipment/ technology. Limits the size of individual grants to no more than $150,000.
Increases funding for Community Health Grants to FQHCs, Rural Health Centers, free clinics, etc. by $7.5 million annually, also adds four positions on which DHHS is limited to $200,000 in funding. Also allows for $200,000 in administrative costs.
Establishes a Primary Care Advisory Committee to develop a process for grading applications: organizations contributing members to the Committee will include, the NC Cmty Health Center Assoc, the NC Assoc of Local Health Directors, the NC Assoc of Free and Charitable Clinica and the NC School-based Health Alliance, et al.
Restricts grant recipients from using money to increase pay for management, supplant existing funds, such as federal funds, or finance any debt.
Orders the Office of Rural Health to create standard quality and outcome metrics for grant recipients and require grant recipients to report on their outcomes.
Budgets $1.2 million annually for contract services to develop and roll out new software in the Controlled Substances Reporting System. Pays $128,000 over the biennium for six people to do the work of maintenance and support of the system.
Provides a total of $3.6 million in one-time funding over the biennium, plus $627,134 in annual funding starting in FY 18-19 to replace outdated computer applications used by DHHS. The money is also intended to develop online hospital/clinic/ provider licensure and renewal in the Division of Health Service Regulation and eliminate the current paper-based process. This also means the licensure information can be provided to the NC Tracks Medicaid billing system.
Creates $1 million in annual funding and $3 million in one-time funding to upgrade the Health Information Exchange (where hospital records talk to one another to track patient care and billing). The funds will also provide ongoing support for the HIE’s database maintenance and support.
Appropriates $600,000/ year to create a computerized registry of Alzheimer’s patients at the Institute of Medicine.
Orders the Office of Rural Health to combine several loan repayment programs targeted at physicians, psychiatrists and those who work in state facilities. This new program can be extended to primary care providers, general surgeons in Critical Access Hospitals and telemedicine providers.
Provides $3.86 million in one-time funding over the course of the biennium to determine what the NC Tracks Medicaid management system will need to align with federal standards. This is required to receive continued funding from CMS.
Orders DHHS to cut $3.2 million per year for contracted services for both years. This money had been cut in FY 16-17, but Gov. Cooper had asked for this money in his budget for the coming two years. This money had been used in the past to pay consultants and other hirees from outside the department. But restricts DHHS from reducing funds earmarked for direct services.
Orders DHHS to deliver a report on the Office of Program Evaluation Reporting and Accountability (OPERA), which was created in the 2015, budget by December 2017. The report should include breakdowns of the office’s accomplishments, spending, organization and details of barriers to operation. OPERA was created to be an independent evaluator of programs within DHHS.
Mandates a proposal from the UNC Chapel Hill School of Government for the creation and administration of a program to train management-level contract specialists in DHHS. These types of employees will be managing contracted services for the state once the Medicaid program switches from a fee-for-service program to being one under outside management.
Creates up to $3 million in one-time funding to support a residency program at Cape Fear Valley Medical Center affiliated with the osteopathic school at Campbell University School of Medicine. This money should be used to replace federal dollars lost when Cape Fear Valley changed from being classified as “urban” to “rural.” Requires that OSBM certify the amount that Cape Fear Valley MC has lost in federal payments. Also requires that CFVMC create residency programs with a minimum of 130 additional slots. Requires a report on expenditures by April 2018.
Competitive grants for nonprofit organizations: Sets aside $10,653,911 in recurring funds for each year of the biennium, in addition to one-time funds of $4,202,500 per year. (with $1.6M / year coming from the Substance Abuse Prevention and Treatment Block Grant) to fund nonprofit organizations which provide services with state dollars. Sets out procedures, etc, for the organizations to receive the funds. Specifically sets aside $350,000 for Big Brothers Big Sisters and a total of $3.225M for TROSA and $2.75M / year to the Boys and Girls Clubs for dropout prevention programs. Reduces the amount of competitive grants for nonprofit organizations by $53,911, to $1,600,000, also extracts an additional $250,000 from the Social Services Block Grant to pay for competitive grants to nonprofit organizations.

DIVISION OF CHILD DEVELOPMENT AND EARLY EDUCATION

DIVISION OF CHILD DEVELOPMENT AND EARLY EDUCATION
Provides $125,000 in one-time funding for Cabarrus Partnership for Children. Located in district represented by Rep. L Johnson, Sen. P Newton. Provides $250,000 for Smart Start – Reach Out and Read a statewide program that works with pediatricians to give kids a reading “prescription.
Provides $25,000 in one-time funding for Alliance for Children, a Smart Start partnership in Union County, which advocates for children’s futures by “investing in efforts that strengthen their health, education, and emotional development. District represented by Rep. D Arp, Sen. T Tucker
Provides $50,000 in one-time funding for Alamance Partnership for Children, a program based in Alamance County that administers Smart Start and other programs to help young children. District represented by Rep. D Riddell, Sen. R Gunn
Provides $50,000 in one-time funding for Wilkes Community Partnership for Children, a mobile produce market.” Local Smart Start agency that builds programs for young children.District represented by Rep. J Elmore, Sen. S Randleman
Provides $50,000 in one-time funding fo the Early Childhood Initiative, Transylvania County program that creates activities to aid young children’s learning. District represented by Rep. Cody Henson, Sen C Edwards
Establishes family income eligibility for NC Pre-K at 75 percent of the state median income, which maintains the current eligiblity 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. Creates a requirement for a criminal record check of any employees (and job applicants) for jobs where they will be accessing federal tax information for any other employees, contractors or job applicants. This will require a fingerprint check and other identification materials. All fingerprints will be forwarded to the State Bureau of Investigation for criminal record checks. And the Department of Public Safety can charge a fee to do this work.
Appropriates additional $3 million in annual funds in FY 17-18 and $6.1 mililon in FY 18-19 to “reduce” the current waiting list for NC Pre-K services by providing an additional 3,525 slots by FY 18-19. Orders that in coming fiscal years, funding for NC Pre-K should be increased by $9,350,000 in FY 2019-20 and by $18,700,000 in FY 2020-21. Usually, a legislature cannot dictate expendutures for any future legislature, unless that appropriation is deemed a “statutory appropriation,” as defined by GS 143 C-1-1(d)(28), which in this case the budget language does.
Above money will be augmented by moving funds from the TANF Block Grant. According to the House calculations, this will serve an additional 1,725 children in FY 17-18 and 3,525 more children than current numbers in FY 18-19. Total General Fund NC Pre-K appropriation = $69.6M in FY 17-18 and $72.7M in FY 18-19. Moves additional $50 million in TANF Block Grant money into NC Pre-K, replacing General Fund dollars on a recurring basis. This swap out utilized $50 million from the Child Care and Development Block Grant to backfill NC Pre-K needs. According to calculations, total of 3,700 more children served. The amount withdrawn was originally budgeted to be $12 million but increased the amount withdrawn from the TANF block grant, now totals $62 million. Net General Fund appropriation for NC Pre-K for FY 18-19 decreases accordingly to $22.65M
Requires DCDEE to issue multi-year contracts for child care centers, specifies building and program standards, and orders an annual report to be delivered to the Legislative Oversight Committee on HHS by March 15 of each year.
Orders DHHS to collaborate with the Department of Public Instruction to create a “statewide vision for early childhood education.” Orders a follow-up report to be delivered by January 2018 and details what needs to be in the report. Also calls for DHHS & DPI to work together to create a standardized program to transition from Pre-K to kindergarten.
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 10 percent of family income. Sets new standards about cost sharing for families, requiring that care received at blended rate, that the copayment will = 83% of the full-time copayment. Increases amount of TANF Block Grant money dedicated to the Child Care Subsidy program from $58,112,735 to $68,070,412. General Fund appropriation going to Child Care Subsidy decreases by $172,000 to $55,821,044, reflecting the elimination of two positions that were unfilled for more than one year.
Moves $ 3.3M in TANF Block Grant moneys to incease the rate paid for Child Care Subsidies in the amounts of $13 million in FY17-18 and $17 million in FY18-19. The market rate for infants to 2 year olds in the 3-, 4- and 5-star centers in low-income counties will increase this October, with funding of $10M in FY17-18 and $13M in FY18-19. Also effective in October, the market rate for older preschoolers will be increased in the same child care centers. Orders DCDEE to create a separate 0-2 years star-rating license standard for child care agencies. Criteria to be included are: staff qualifications, turnover rates, educational outcomes, evaluation of religious-based child care centers and minimum requirements for those. Orders a draft recommendation be delivered to HHS oversight committee by November.
Increases child care subsidy rates beginning in October to market rates for 3-,4- and 5-star faciliites for school aged children in tier 1 & 2 counties. Adds $3M in FY 17-18 & $4M in FY 18-19 for increases to the market rate for school-aged children. Starting October, 2017, increases subsidy to market rate for 0-2 year old children in 3-, 4- and 5-star facilities in Tier 3 counties. Uses, for this purpose, the NC Dept of Commerce County Tier designations from 2015. Increases child care subsidy rates as per the 2015 Child Care Market Rate Study as noted in last year’s budget. In addition, beginning in Oct 2018, increases rates paid for 3-5-year-old children in 3-, 4-, and 5-star facilities in the state’s least economically distressed counties, a total of $9,750,000 in funds from the Child Care and Development Block Grant. Also in Oct 2018, increases child care subsidy up to 100 percent of the market rate reported in the 2015 study for children 0-5-years-old in 3-, 4- and 5-star facilities in the state’s less economically advantaged counties. This requires $3,675,000 of funds from the Child Care and Development Block Grant. (Last year, these provisions only covered children 0-2 years old.) For this purpose, use the NC Dept of Commerce County Tier designations from 2018.
Total Subsidized Child Care appropriation = $52.6M in FY 17-18 and $56M in FY18-19; federal funds make up the bulk of child care subsidy. Total Subsidized Child Care appropriation = $55.8M in FY18-19; federal funds make up the bulk ($340M) of child care subsidy, including an additional $19.575,000 moved from TANF and Child Care and Development Block Grants that are used to reduce the waiting list.
Total Smart Start – subsidized child care General Fund appropriation = $143.5M for FY 17-18, $147M in FY 18-19 Smart Start – subsidized child care General Fund appropriation requires an additional $375,000, this includes $250,000 for Reach Out and Read and a total of $125,000 to local partnerships; Total = $147.3M in FY 18-19. In addition, Smart Start receives $7 million from federal Child Care Development Block Grant, for a Grand Total: $154.3M
Swaps out a total of $687,117 in TANF Block Grant funding on a one-time basis over the biennium to help fund the Child Care Subsidy program.
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 includes language that allows the Division to withhold up to 2% of available funds as a hedge against fraud/ program termination because of fraud and having to pay back federal funds as a result. Adds a new reporting requirement, for 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% 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.
Moves $913,972 from the Child Care and Development Fund Block Grant to create 12 positions in DCDEE to oversee infant-toddler projects, run the Child Care Subsidy program, and provide workers for compliance and fraud detection and policy/planning. The rest of the workers will support professional development, assessment and licensing. Most of these services are paid for by federal receipts. Moving the block grant money over allows for additional personnel and services with a minimum of General Fund money. Moves $471,990 in additional money from the Child Care and Development Fund Block Grant to add 7 positions to improve quality and access of infant/ toddler care. Those positions are: Lead Investigation Consultants (2), CDC Training/ Planning Development Supervisor, Investigation Manager, Administrative officer, Processing Assistant, Office assistant. Moves an additional $223,308 from the same block grant for Business office positions. Total extracted from the CCDFBG = $695,298
Sets out rules for how counties might reallocate funds left over after providing child care subsidies. Instructs counties to use the market rate increases in the formula, rather than old funding formulas.
Sets out language to create general statute requirements for child care matching funds, loan funding and administrative allowances. They will appear in a new part of the state code entitled: Child Care Subsidy. For example, allows counties to set aside up to 4% of the child care subsidy funds (or $80,000, whichever is greater) for fraud detection.
Orders DHHS and DCDEE to implement a plan created by a 2015 law to require parents who have custody of their children to cooperate with child support service programs as a condition of receiving the child care subsidy. DHHS / DCDEE needs to report on how this implementation is proceeding by October 2018. Increases fees paid for child support services to comply with federal law from $25/ year to $35/ year for families who have received more than $550 in support services.
Orders NC Partnerships for Children to insure policies focus on assisting 1-, 2- and 3-star rated faciliites to improve their ratings and implementing Pre-K evidence-informed programs to increase literacy, provide parenting education, and improve child health. Caps administrative costs for local partnerships at 8 percent and orders the NC Partnership for Children to use a single statewide contract management system, with all local partnerships participating. Sets out salary criteria for Partnerships.
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%. Sets out criteria for what constitutes and how to account for in-kind donations. Keeps fundraising match requirements for the statewide Partnership to Children and local affiliates the same as FY 17-18, adds a requirement for a report submitted annually by Oct 1 to the HHS oversight committee.
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. Keeps other mandates written into 2017-18 budget, adds a stipulation that local partnerships may only use one percent (1%) of state dollars for fundraising activities. Also mandates that in the annual report, the partnerships detail the amounts used for fund-raising, any return on fund-raising investments and other “information deemed relevant.”
Orders allocations in smaller counties to not drop below 2012-13 levels, sets forth instructions for evaluation system, and sets expenditure restrictions
Appropriates $3.5 million in annual funds in FY17-18 and $7 million in recurring funds in FY18-19 to allow for access to Dolly Parton’s Imagination Library, an early literacy program that mails age-appropriate books to registered children monthly. Stipulates the NC Partnership for Children may use up to 2 percent of funding for program evaluation. Stipulates that the NC Partnership for Children may only use one percent (1%) of funds for statewide program management and one percent for program evaluation of the Dolly Parton Imagination Library program. Reduced from the ability to use two percent (2%) for evaluation.

DIVISION OF SOCIAL SERVICES

DIVISION OF SOCIAL SERVICES
Provides $50,000 in one-time funding for Waves 4 K.I.D.S in Brunswick County. Located in district represented by Rep. D Butler, Sen. Bill Rabon Provides $50,000 to Children’s Homes of Cleveland County, a nonprofit that provides basic services to families in need. District represented by Rep. K Hastings, Sen. W Daniel
Provides $50,000 in one-time funding for Restoring Hope Center in Laurinburg. Located in district represented by Rep. G Pierce, Sen. T McInnis Provides $75,000 in one-time funding to the Outreach Center, which provides education, food and support services to families in Morganton. Located in district represented Rep. H. Blackwell, Sen. W. Daniel
Provides $75,000 in one-time funding for Northern Moore Family Resource Center in Moore County. Located in district represented by Rep. J Boles, Sen. J Tillman Provivdes $25,000 in assistance to the Union County Crisis Assistance Ministry, a food pantry and basic service provider for residents in “severe financial need.” Located in district represented by Rep. D. Arp, Sen. T Tucker
Provides $250,000 in one-time funding for Children’s Home of Cleveland County. Located in district represented by Rep. K Hastings, Sen. W Daniel. Provides $30,000 in one-time assistance to StepUp Wilmington, which helps low income and disadvantaged people apply for and get full-time jobs. District represented by Rep. D Butler, Sen. M Lee
Provides $200,000 in one-time funding for Crossnore Children’s Home in Winston-Salem. Located in district represented by Rep. J Dobson, Sen. D Ballard. Provides $50,000 in one-time funding for the Crisis Control Center, the Shepherd’s Center and Next Step Ministries, all funded by the Kernersville Foundation. District respresented by Rep. D Conrad, Sen J Krawiec
Provides $100,000 in one-time funding for Dragonfly House, an advocacy center for recovering victims of child abuse, operating out of Mocksville. District represented by Rep. J Howard, Sen. D Barrett
Notes approval of DHHS’ state plan for spending TANF (Temporary Assistance for Needy Families) monies covering October 1, 2016 – September 30, 2019. Designates Beaufort, Caldwell, Catawba, Lenoir, Lincoln, Macon and Wilson counties as “electing counties” with some flexibility in administering the plan and delivering services. (Those counties combined can contain no more than 15.5 percent of the state’s Work First/ welfare cases). 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. Provides $25,000 in one-time funding for the Northern Moore Family Resource Center for expansion of services at Hope Academy. Offers after-school programs, summer camps and other programs that involve early-childhood education. District represented by Rep. J Boles, Sen. J Tillman
Appropriates $2.75 million in annual funds from the Social Services Block Grant to become grant funding for county social services. Several years ago, when the SSBG was reduced, NC replaced this money with General Fund dollars. The SSBG has increased again, and this move puts this money back into the General Fund and pays for the grants with SSBG money. Provides $50,000 in one-time funding for the North American Mission Board, or the Inner City Housing Ministries in Winston-Salem” a Southern Baptist-focused organization that brings help to those in need.
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. Provides $150,000 in one-time funding to Crossnore School and Children’s Home, a school for foster children in need. District represented by Rep. J Dobson, Sen. D Ballard
Provides $40,000 in one-time funding to Boys and Girls Clubs of Wilmington, which offers after-school programs for young people. District represented by Rep. D Butler, Sen. M Lee
Total of irregular one-time funding appropriated under the Division of Social Services added to Reserves and Transfers budget line, increasing total to $1.4 in General Fund obligations.
Provides a one-time appropriation of $1 million for Child Advocacy Centers, in addition to $207,000 / year coming from the Social Services Block Grant. Up to $100,000 will go to centers in good standing and $100,000 to Children’s ‘Advocacy Centers of NC, Inc for operations. Moves $1 million in Social Services Block Grant funds to provide for Child Advocacy Centers, the money has changed from being one-time funds to being recurring funding.
Provides $750,000 in one-time funding for the Children’s Center of Surry, runs support programs for parents, families and youth in Surry, Stokes, Wilkes, Yadkin and Forsyth counties. HQ in district represented by Rep. S. Stevens, Sen. S. Randleman
Sets out temporary rules for setting rates for child care institutions funded by DHHS; limits reimbursement rates for the institutions to the rate established by the Dept/ Controller until the Social Services Commission sets standardized rates. Budget for Family Preservation and Support increased by $850,000
Moves $338,000 annually from the Social Services Block Grant to fund the Child Medical Evaluation Program, which pays for evaluations of children who may have been physically or sexually abused. Funding in DSS is primarily for children who are not Medicaid-eligible because Medicaid pays for the evaluation for Medicaid and CHIP eligible children. Also increases the rate paid for Medicaid eligible children who are suspected of being abused or neglected to $575/ exam. This will cost $385,000 in annual funds.
Sets out budget guidelines for how DHHS Division of Social Services can use funds to support the provision of foster care services. 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.
Orders DHHS / Child Support Services Section (NCCSS) to retain up to 15 percent of annual federal incentive payments and allocate no less than 85% 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.
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.
NCCSS is to have county DSS’s 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.
Appropriates recurring funding for the changes required by federal officials in response to North Carolina’s failing grade on the Child Welfare review program improvement plan. The funding is $8.7 million in annual funds, increasing to $9.146 million in FY18-19 with an additional $330,521 in one-time funding in FY18-19. The money is intended to allow for the professional development and training of child care workers in counties. It will also provide in-home services and services for children who have been adopted. The money also will support “medical homes” for adoptive children. The non-recurring money in the second year is to create a program for preventing unnecessary out-of-home placement for youth with behavioral and emotional needs and to perform a County Child Welfare workforce study.
Changes to the Child Welfare System – DHHS is ordered to continuing 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 work with county DSSs to create oversight plans that include staff training, quality improvement and data analysis. Report to the legislature every six months in February and August. Changes the reporting period to within 30 days of complete implementation of the child welfare system improvement plan, and orders a final report to be deliveered to the HHS oversight committee no later than 90 days after implementation is complete.
Changes to the Child Welfare System – orders DHHS to get child welfare component of NC FAST system online by the end of 2017 and to report to the NCGA on development and deployment of the software quarterly. Orders the HHS Oversight committee to be notified within 30 days of implementation of the child welfare portion of NC FAST. And then orders a final report on the NC FAST implementation to be delivered by 90 days of implementation.
Uses $684,806 in TANF Block Grant dollars to continue implementation of NC FAST. Also reduces NC FAST money for implementing the Child Care Component of the system by $30,866, which would have come out of the Child Care Development Fund (federal block grant).
Orders DHHS/ DSS to continue implementing an evidence-based pilot program started in 2016 to improve care and access to benefits for dual eligible seniors to improve their health and independence while reducing costs. DSS is working with a not for profit (sources say senators are thinking of Benefits Data Trust) to identify seniors eligible for SNAP, create an outreach program, sign seniors up for benefits and do measurement and evaluation. Orders a report due on February 1, 2018 and stipulates that any leftover funds not revert to the state, but rather remain available for implementation of the pilot. Provides funds to continue the pilot outreach program that increases access for SNAP (food stamp) services to seniors who are dually eligible for Medicare and Medicaid. Adds $420,000 in one time funds for the pilot, and an additional $600,000 for the total Food and Nutrition Services budget.
Creates a “Foster Care Transitional Living Initiative Fund” to support transitional living services that produce good outcomes for foster youth aged 17-21. 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 availabale 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.
Provides $5000,000 in annual funds to Youth Villages to provide services to improve outcomes for youth ages 17 to 21 who are transitioning from the foster care program. This means the program will receive $2.5 million each year in total funds.
Appropriates additional funding in $750,000 in one-time funding each year to support the Permanency Innovation fund, which works to find permanent homes for foster care youth. This money will be combined with $218,878 in receipts. Requires private partners to match 50% of state dollars allocated.
Makes some changes to the Permanency Innovation Initiative Oversight Committee to broaden the committee’s look at initiatives and oversight for programs that support foster care kids transitioning to adulthood.
Provides $5000,000 per year in continued funding for the Eckerd Kids / Caring for Children/ Angels Watch programs which helps place children ages 0 to 6, with siblings up to age 10 into non-state foster care when parents are temporarily unable to care for those children (e.g. in case of the death of a spouse). Parents are also provided mentorship to help them address issues and better parent their children while they are placed elsewhere. Requires report about number of families/ children served, with a comparison to other similarly-situated chidren, to be delivered by Dec. 2018. Orders that this program not only support children 0-10 years old, but also any siblings under the age of 18 years old. The rest of the mandates remain the same.
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. Eliminates a quarterly report that was due on how this transition was progressing.
Moves $1.27 million annually from DSS account over to the Division of Medical Assistance. This is the funding for non-emergency transportation to be charged to Medicaid rather than to Social Services.
Appropriates $300,000 in one-time funding each year to support Marketing Association for Rehabilitation centers. This program focuses on business development and creates new job opportunities for people who are chronically unemployed.
Makes expenditure of child welfare funding in lines 96-101 contingent on the passage of House Bill 630. Also makes funding of $161,439 in FY17-18 and $3,229,695 in FY18-19, both one-time funding contingent on passage of the bill.
Increases the funding to support an anticipated increase in foster care caseloads by $270,903 in FY17-18 and by $2.45 million in FY18-19.

DIVISION OF AGING AND ADULT SERVICES

DIVISION OF AGING AND ADULT SERVICES
Provides $100,000 in one-time funding for the Charlotte Neuroscience Foundation – Memory Center. Located in district represented by Rep. Becky Carney and Sen. Joyce Waddell. Provides $125,000 in one-time funding for the Memory Center of Charlotte, via the Charlotte Neuroscience Foundation. The Memory Center is an Alzheimer’s disease treatment center that focuses on family engagement. District represented by Rep. B Carney, Sen. J Waddell.
Provides $125,000 in one-time funding for Hospice of Davidson County. Located in district represented by Rep. S Watford, Sen. Joyce Waddell. Provides $127,000 in one-time funding for Cleveland County Rescue Mission, a faith-based organization that provides food and shelter to those in need in the county. District represented by Rep. K Hastings, Sen. W Daniel
Provides $250,000 in one-time funding for Senior Resources of Guilford. Located in district represented by Rep. A Quick, Sen. G Robinson Provides $57,000 in one-time funding to the township of Sanford to support services for people experiencing homelessness. District represented by Rep. R Reives, Sen. J Rabin
Provides $100,000 in one-time funding for the East Spencer Housing Authority. Located in district represented by Rep. Carl Ford, Sen. A Brock Provides $100,000 in one-time funds for the Open Door Community Center the first homeless shelter for women and children in Beaufort County. District represented by Rep. M Speciale, Sen. W Cook
Provides $250,000 in one-time funding for the Life Enrichment Center in Shelby. Located in district represented by Rep. K Hastings, Sen. Warren Daniel Provides $50,000 to Allied Churches of Alamance County, Inc. which works to unite churches of different denominations to provide basic services for people in need. District represented by Rep. Dennis Riddell, Sen R Gunn
Provides $100,000 in one-time funding to The Shepherd’s House. Located in district represented by Rep. Sarah Stevens, Sen. S Randleman Provides $10,000 in one-time funding to Friends of the Homeless Shelter in Kinston, which provides food and shelter for the homeless population of Kinston. District represented by Rep. G Graham, Sen. D Davis
Provides $35,000 in one-time funding for the Bolton Senior Center in Columbus County. Located in district represented by Rep. B Jones, Sen. D Britt Provides $25,000 in one-time funding to the East Arcadia Senior Center for older adults “for the purchase of a building.” District represented by Rep. W Brisson, Sen. B Rabon
Provides $231,155 in one-time funding fo the Lincoln County Senior Center for the following purposes: $56,155 for the Senior Center to purchase a van and $175,000 for senior center furnishing and technology. District represented by Rep. J Saine, Sen. D Curtis
Provides $5,000 in one-time funding for the South Granville Senior Center. District represented by Rep. L Yarborough, Sen. F McKissick
Provides $5,000 in one-time funding for the Person County Senior Center. District represented by Rep. L Yarborough, Sen. M Woodard
Provides $250,000 in one-time funding for Senior Resources of Guilford for the renovation of a new building.” Community center for older adults, with a focus on promoting independence. District represented by Rep. P Harrison, Sen. G Robinson
Provides $125,000 in one-time funding for the Montgomery County Council on Aging for acquiring a new building.” County initiative that helps senior citizens by offering activities and other opportunities. District represented by Rep. J Burr, Sen. C Dunn
Provides $20,000 in one-time funding to the government of Columbus County to purchase a van to be shared by the 7 Columbus senior centers. District represented by Rep. B Jones, Sen. D Britt
Appropriates $5 million/ year to increase the rate paid for adult care homes that receive state-county special assistance funding payments for low-income patients. Adds $34/month per resident to payment for two years only, requires counties to pay 50% of the cost of providing for these residents. ‘ Reduces funding by $2.2 million for temporary services to assist group homes that serve people who receive state/county Special Assistance, due to decreasing caseloads. A total of $1.1 million reverts back to the General Fund.
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).
Authorizes the HHS Secretary to waive the 15% cap on the number of special assistance in-home payments as necessary within a county’s Special Assistance budget. Creates plan for the Eastern Band of Cherokee Indians to assume responsibility for administering the Home and Community Care Block Grant for people living under their jurisdiction. Reduces the allotment from the HCCBG to the Southwestern Commission Area Agency of Aging by $43,731, and provides those dollars to cover a contract of equal size with the Eastern Band of Cherokee Indians.
Provides $969,999 in each year of the biennium to enhance the Home and Community Care Block Grant, which pays for services such as Meals on Wheels. This is a continuation of non-recurring funding from prior years and does not address the waiting list for services. Adds $1M in additional federal funds for congregate meals by moving $150,000, from the Social Services Block Grant to NC’s Home and Community Care Block Grant program. With local matching dollars of $167,667 and federal receipts, brings that total of federal dollars to $2.69M. No new state dollars. https://www.northcarolinahealthnews.org/2018/05/29/state-funding-lags-as-nc-seniors-face-threat-of-hunger/
Moves additional $850,000 in recurring Social Services Block Grant dollars, to the Home and Community Care Block Grant program, with an additional $94,444 in local matching dollars to provide $944,444 in funding for in-home and community-based services to allow older adults to continue living at home with supports. No new state dollars.
Moves $605,101 in funding from the federal Social Services Block Grant to provide an increased rate paid to corporate guardians and to serve some extra people. Total budget for guardianship = $3,766,119, using $520.649 in NC General Fund money. Moves $1,316,412 from the federal Social Services Block Grant to provide additional Adult Protective Services and Guardianship. In addition to planned $1,352,250 from the General Fund to provide services.
Moves $81,758 in funding from the Social Services Block Grant to provide salary/ benefits for one Social Work Planner/ Evaluator to support Adult Protective Services in all 100 county’s DSSs. No new state dollars.
Changes the timeline for submitting biennial plans for the division to July of odd-numbered years (the first year of the biennium) and stipulates the contents of the biennial plans. This aligns the reporting period with federal deadlines.
Recommends the formation of an Aging subcommittee to the Joint Legislative Oversight Committee on Healht and Human Services. Reports: interim report March, 2018 and Final report Nov. 2018.

DIVISION OF PUBLIC HEALTH

DIVISION OF PUBLIC HEALTH
Provides $100,000 in one-time funding for the Coastal Pregnancy Center in Beaufort County. Located in district represented by Rep. B Boswell, Sen. B Cook Provides $35,000 in one-time funding for Wayne Initiative for School Health (WISH), an initiative by Wayne County that aims to provide healthcare to students who, otherwise, wouldn’t receive services. District represented by Rep. L Bell, Sen. D Davis
Provides $100,000 in one-time funding for the Greene County Wellness Center. Located in the district represented by Rep. G Graham, Sen. D Davis
Provides $450,000 in one-time funding for the Monroe County-based Pregnancy HELP Center, Inc. Located in the district represented by Rep. C Horn and Sen. T Tucker
Provides additional one-time funding for the UNC Craniofacial Center at the UNC School of Dentristry. Located in the district represented by Rep. V Insko and Sen. V Foushee
Alters and codifies language around the use of school nurse funding and notes any money for extra school nurses not be used for other efforts and can’t be used to pay for nurses working at state agencies. Also sets stipulations on the funding, including county/school eligibility for the funding and what the nurses can and can’t do.
Allocates $690,594 in annual funds for the Children’s Developmental Service Agencies (CDSAs). The appropriation is enough money for eight positions to address deficiencies identified in a federal corrective action plan in two of the CDSAs – New Bern and Blue Ridge. The funds will provide for an OT, PT and SLT for each CDSA, a psychologist for New Bern and an additional OT for Blue Ridge.
Directs $2.0 million in annual funds to expand the home visiting services of the Nurse Family Partnership. This brings the total appropriation for NFP to $3.7 million per annum. Instructs DHHS to submit a waiver to federal regulators in order to be reimbursed by Medicaid for a plan to expand the Nurse Family Partnership home visiting program for at-risk mothers and children. Instructs DHHS to create a report to the legislature about the expected savings from this pilot program and timeline for statewide implmentation, expected outcomes and potential savings. Then, after the conclusion of the pilot program, DHHS is instructed to submit a report to the legislature on actual outcomes and savings associated with statewide expansion.
Orders DHHS to begin providing Medicaid/ Health Choice coverage for an infant home visiting program modeled on the Nurse Family Partnership, either as statewide program or as a pilot program. Orders DHHS to design the program, define the scope of the program, and determine the fiscal impact of such a program by July 2018. The plan should also include plans on how to leverage state dollars to find private dollars and a timeline for implementation.
Appropriates $500,000 in annual funds to expand the Quitline NC and You Quit, 2 Quit, a smoking cessation program for pregnant women. Quitline received about $800,000 in appropriations last year and also earns receipts from the State Health Plan which uses the service for its members. Appropriates $250,000 in annual funds to support the Quitline NC and You Quit, 2 Quit, a smoking cessation program for pregnant women (in addition to $500,000 budgeted last year). Quitline also earns receipts from the State Health Plan which uses the service for its members.
Appoints $500,000 in one-time funding in each year for youth tobacco prevention programs to prevent the use of new and emerging tobacco products, including e-cigarettes. Appropriates an additional $250,000 in one-time funds for youth tobacco prevention programs (on top of the $500,000 budgeted) to prevent the use of new and emerging tobacco products, including e-cigarettes.
Of the funds designated for the Division of Mental Health, Developmental Disabilities and Substance Abuse Services, legislators order that $300,000 be transferred to the Alcohol Law Enforcement Branch to fund checks on stores selling tobacco and tobacco products to minors. Note: The state is required to demonstrate compliance in order to maintain $16M in federal block grants.
Asks for a report – due in March 2018 – to address how to reduce the budget deficit at the State Public Health Lab in Raleigh. Asks for recommendations including what currently free services could be changed to require a fee, creation of a billing system, and the feasibility of altering the state’s Medicaid plan to take advantage of federal cost settlement. Appropriates $80,000 in annual funds for an initiative with the Perinatal Quality Collaborative NC (PQCNC) to improve accuracy of birth certificate data.
Provides $2 million in one-time funding and $1 million in annual funding for the state public health lab to address a structural deficit. The deficit was created several years ago when the state stopped charging Medicaid for the infant genetic/metabolic panel, which costs about $100/infant. Last year, the state allowed for the lab to charge about $40 for infant testing, but there remains a deficit. Increases the fee for newborn genetic testing from $44 to $128/ infant. This fixes a structural problem where the State Lab was being reimbursed too little for infant screening tests, thus generating a deficit and will generate $6.4M in receipts annually. This money helps with adding 7 positions in the Newborn Screening Program. $3.7M of this money budgeted for equipment procurement, upkeep and replacement to perform the testing.
Adds new screening tests to the infant genetic testing screening panel. Added diseases to be tested for are: Pompe disease, Mucopolysaccharidoses (MPS I) and X-linked Adrenoleukodystrophy. Parents are given the option of opting out of testing.
Also creates the Newborn Screening Equipment Replacement and Acquisition Fund, wich receives $32 of each fee paid to be applied to the Newborn Screening Program. Also this also facilitates that North Carolina comply wiht the national U.S. Recommended Uniform Screening Panel for infant screening. Also mandates an annual report on the Newborn Screening program, which will include budget.
Requires an annual report to the legislature on the state’s newborn screening program, including budget, fees and receipts, additions to the state’s program that come from the US RUSP, equipment needs, etc.
Sets up competitive process for granting funds to local health departments for improving maternal and child health, based in part on current health indicators and whether grant proposals incorporate evidence-based programs. Creates priority for proposals that “leverage non-state funds in addition to the grant award” and stipulates that any funding received by the state for this purpose not supplant existing funds for maternal or child health. Orders the HHS Secretary to announce grant recipients by July 1 and orders health department reports on grant spending and impact by December 1 of each year. Final budget adds $1.85M in FY 17-18 and $1.3M in FY 18-19 to “Maternal and Infant Health” programs, for final appropriation of $13.7M in FY 17-18 and $13.1M in 18-19.
Orders a study of the fees paid to keep/ create vital records such as death certificates, etc. to determine whether income from services rendered covers costs.
Appropriates $300,000 in recurring funds/ year and $300,000 in one-time funds per year for communicable disease testing with an emphasis on testing for Hepatitis C and other priority diseases. The money may also be used by the DPH to assist people who test positive to access the appropriate health care treatment.
Carries forward language from the 2015 budget that cuts Planned Parenthood out of bidding for contracts to provide adolescent pregnancy prevention services.
Appropriates $1.3 million annually to the Carolina Pregnancy Care Fellowship, $800,000 to buy durable medical equipment for clinics. Up to $30,000 annually may be used for administration and up to $170,000 / year may be used to train staff on how to use the DME. In addition, provides $400,000 in Maternal and Child Health Block Grant funds to Carolina Pregnancy Care Fellowship. Appropriates $1M for the Carolina Pregnancy Care Fellowship, with same breakdown: Appropriates $1.0 million annually to the Carolina Pregnancy Care Fellowship, $800,000 to buy durable medical equipment for clinics. Up to $30,000 annually may be used for administration and up to $170,000 / year may be used to train staff on how to use the DME.
Also appropriates $300,000 in one-time funds/ year to develop and implement a contimuum of care pilot program for the Human Coalition clinic in Raleigh. Part of the study will be to assess why women seek abortions and provide a contimuum of care to assist women to carry pregnancies to term. Stipulates the funds are “nonsectarian purposes only.” The pilot should include matching 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.” Report due April 1, 2018 and final report due April, 2019. Continues the annual (non-recurring) grant of $300,000 to develop and implement a contimuum of care pilot program for the Human Coalition clinic in Raleigh. Part of the study was be to assess why women seek abortions and provide a contimuum of care to assist women to carry pregnancies to term. Stipulates the funds are “nonsectarian purposes only.” The pilot should include matching 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.” Fnal report due April, 2019 which should include potcost of expanding the pilot statewide, an estimateof any potential savings from the program and a potential timeline.
Pulls $250,000 from the TANF Block Grant to fund Teen Pregnancy Prevention programs run out of the Division of Women’s and Children’s Health, also pulls an additional $2.85M of federal Maternal and Child Health Block Grant dollars annually to cover costs in the Division.
Directs $100,000 in start-up funding for the Advisory Council on Rare Diseases, which was established by law in 2015 and is housed at the School of Public Health at UNC Chapel Hill.
Provides $2.2 million per annum in one-time funds to launch a three-year demonstration of the “Every Week Counts” program that is intended to improve infant mortality outcomes in Robeson and Columbus counties. Researchers from UNC Chapel Hill’s School of Public Health will lead the project, which will provide in-home prenatal care for low-income multiparous women. They will also conduct a randomized controlled trial of the use of 17-p, a drug used to reduce the risk of preterm birth, among women deemed to be at risk of preterm birth. Lays out inclusion criteria for program participants. Final report to be submitted three months after conclusion of the program. Provides $3 million in one-time (non-recurring) funds to launch a three-year demonstration of the “Every Week Counts” program that is intended to improve infant mortality outcomes in Robeson and Columbus counties. Transfers oversight to researchers from UNC Pembroke to lead the project, which will provide in-home prenatal care for low-income multiparous women. UNC Pembroke is tasked with finding $3 million in matching funds to continue the demonstration project for a third year, completing all of the tasks outlined in Year 1. That money “may” be raised by the UNC Chapel Hill School of Medicine. Final report to be submitted three months after conclusion of the program.
Orders DHHS to continue administering an evidence-based diabetes prevention program and asks for annual report to be delivered to the NCGA by December 1 of each year.
Implements new federal standards for the definitions of “elevated blood lead level,” “confirmed lead poisoning” and “readily accessible substance” (a substance that can be eaten by a child or pregnant woman) used in North Carolina, introducing more stringent standards. It lowers the level of lead found in the blood of a child or a pregnant woman that requires immediate action to remove lead from the immediate environment, as recommended by the CDC.
Budgets federal Medicaid receipts to conform the state’s elevated blood level standard with the federal standard. These receipts, totalling about $557,000 in FY17-18 and $559,000 in FY18-19 will fund six full-time positions to handle the workload.
Budgets federal receipts of $3.8 million from the WIC program to move recipients from paper vouchers to an electronic benefits transfer (ATM-like) card for purchasing food.
Instructs DHHS to work with the Department of Public Safety to buy HIV medications for those in prison who have been diagnosed in a manner that allows the state to draw federal matching funds.
Orders DHHS to continue using ADAP funds to purchase health insurance or provide premium/copay/deductible assistance for patients with HIV to use federal “Ryan White” funds to pay for insurance that guarantees them access to medication. Orders a study of the program that demonstrates cost neutrality, gives data on health outcomes and describes any obstacles to implementation by March 2018. Reduces the amount that the Division of Women’s and Children’s Health pulls out of the Substance Abuse Prevention and Treatment block grant by $724,461. Now, only $241,488 comes out of the SAPT BG to pay for HIV testing.
Sets the eligibility determination for ADAP recipients by calculating “modified adjusted gross income,” which brings the program in line with other benefit program eligibility determinations.
Allots $2.2 million in one-time funding each year to create and conduct a pilot preterm pregnancy program in Robeson and Columbus Counties. The project will fund in-home prenatal care for prevention of preterm birth and use 17-P to prevent preterm births in at-risk pregnant women.

DIVISION OF MENTAL HEALTH/ DEVELOPMENTAL DISABILITIES AND SUBSTANCE ABUSE SERVICES & DIVISION OF STATE OPERATED HEALTHCARE FACILITIES

DIVISION OF MENTAL HEALTH/ DEVELOPMENTAL DISABILITIES AND SUBSTANCE ABUSE SERVICES & DIVISION OF STATE OPERATED HEALTHCARE FACILITIES
Provides $150,000 in one-time funding for Charlotte-Mecklenburg Hospital Authority. Located in district represented by Rep. M Belk, Sen. J Jackson. Provides $50,000 in one-time funding to Triangle Down Syndrome Network of Raleigh, a resource for people and families affected by Down syndrome in the Triangle area. District represented by Rep. C Ball, Sen. J Alexander
Provides $100,000 in one-time funding for Bridge to Recovery, Inc. Located in district represented by Rep. J. Parr, Sen. Tom McInnis. Provides $10,000 in one-time funding for Linden Lodge, a recovery organization that works to help men and women who are recovering from mental illnesses. District represented by Rep. J Boles, Sen J Tillman
Provides $250,000 in one-time funding for development of Opioid Overdose Rapid Response Team in Guilford County. Located in district represented by Rep. J Blust, J Faircloth, C Brockman, J Hardister, A Quick, P Harrison; Sen. P Berger, T Wade, G Robinson Provides $10,000 to the government of Moore County for the purchase of naloxone for first responders. District represented by Rep. J Boles, Sen J Tillman
Provides $500,000 in one-time funding to ReNu Life Traumatic Brain Injury Services. Located in district represented by Rep. J Dixon, Sen. D Davis. Provides $50,000 in one-time funding to ReNu Life, a rehabilitation center for people recovering from traumatic brain injuries. District represented by Rep. J Dixon, Sen. D Davis
Provides $400,000 in one-time funding for GiGi’s Playhouse in Raleigh. Located in district represented by Rep. N Dollar, Sen. T Barringer Provides $50,000 in one-time funding to GiGi’s Playhouse, a recreation and education center for people of all ages with Down syndrome. District represented by Rep. N Dollar, Sen. T Barringer
Provides $100,000 in one-time funding for Sanctuary House. Located in district represented by Rep. P Harrison, Sen. G Robinson. Provides $10,000 to the government of Anson County for the purchase of naloxone for first responders. District represented by Rep. M Brody, Sen. T McInnis
Provides $50,000 in one-time funding for Alexander Youth Network. Located in district represented by Rep. A Dulin, Sen. D Bishop Provides $10,000 to the government of Scotland County for the purchase of naloxone for first responders. District represented by Rep. K Goodman, Rep. G Pierce, Sen T McInnis
Provides $100,000 in one-time funding for The Enrichment Center in Winston-Salem. Located in district represented by Rep. E Terry, Sen. P Lowe Provides $10,000 to the government of Richmond County for the purchase of naloxone for first responders. District represented by Rep. K Goodman, Rep. G Pierce, Sen T McInnis
Provides $50,000 in one-time funding to Samaritan Colony a substance abuse treatment facility in Rockingham, to provide addiction recovery services to women. District represented by Rep. K Goodman, Sen. T McInnis
Provides $25,000 in one-time funding to The Arc of Union/Cabarrus County for services to support individuals with intellectual and developmental disabilities. District represented by Rep. L Pittman, Sen. P Newton
Provides $300,000 in one-time funding to The Bridge to Recovery, a faith-based addiction treatment center in Moore, for treatment of individuals recovering from substance abuse.” District represented by Rep. D Arp, Sen. T Tucker
Provides $50,000 in one-time funding to the Rapid Response Team for Opioids, Guilford County’s program for identifying patients at risk of opioid overdose, and pursuing necessary treatment and prevention. District represented by Rep. J Blust, Rep. C Brockman, Rep. J Faircloth, Rep. J Hardister, Rep. P Harrison, Sen. P Berger, Sen. G Robinson, Sen. T Wade
Provides $500,000 in one-time funding for Holy Angels, a center for people with intellectual and developmental disabilities in Belmont. District represented by Rep. J Torbett, Sen K Harrington
Provides $50,000 in one-time funding to Reality Ministries, a faith-based resource center for teens with developmental disabilities. District represented by Rep. M Michaux, Sen. M Woodard
Adds statutory language to the state’s Executive Organization Act that stipulates that money for the NC Child Treatment Program should be used to train providers in evidence-based treatments, to create statewide standards for measuring accountability and outcomes, to create a roster of clinicians able to provide the above treatments, and to work with management of LME MCOs to make these treatments available to kids in juvenile justice and mental health facilities. Makes adjustments to the Mental Health Block Grant and moves that money toward the budget for the Division of Mental Health, Developmental Disabilities and Substance Abuse Services totalling $6.25M in federal grant money. No adjustment in state dollars. Also Uses additional $2.95M from Substance Abuse Prevention and Treatment federal dollars to the Division.
Directs the use of funds for the Child Treatment Program, which does clinical training on evidence-based mental health treatment for children. Directs DHHS to develop a secure online database to provide individual and aggregate level data and it stipulates that all data entered into this database and other databases, such as NC FAST, remain state property.
Changes how cash is paid to LME/MCOs during the first month of the fiscal year (July) in order to relieve cash-flow problems experienced by the LME/MCOs at that time.
Decreases single stream funding paid to LME/MCOs by a total of $9.74 million annually and by $43.4 million in one-time funds in FY 2017-18 and by a total of $1.96 million in annual funds and by $44.6 million in FY 2018-19. Specifies how those cuts will be distributed among all seven LME/MCOs. Orders the LME-MCOs to maintain the same level of service provision as during the past FY. Orders the HHS Secretary to report to the legislature by March 2018 with detailed explanations about any needed adjustments in these recurring reductions in future years. If there is a Medicaid surplus at the end of each fiscal year, LME/MCOs may receive $30 million to offset the reductions. Changes the decreases in single stream funding paid to LME/MCOs, now costs reduced by an additional $438,042 in annual funding and $16,583,635 in one-time funding. This is a $17.02 million reduction from what was originally planned for FY2018-19, making a total reduction of $36.44 million annually and $71.2 million in one-time funds in FY 20187-19 off what was originally planned for LME/MCOs. Specifies how those cuts will be distributed among all seven LME/MCOs (including reducing cuts to Trillium Health Resources to zero). Orders the LME-MCOs to maintain the same level of service provision as during the 2014-15 FY. Orders the HHS Secretary to complete a comparison of the cash balance and solvency range of each LME/MCO, including detailed explainations.
Also takes $31,487,366 in recurring single-stream funding and redirects those dollars to other services, including: Local three-way crisis beds ($2.5M); Disability Rights Settlement ($6.2M); US DOJ/ Transitions to Community Living ($8.89M); Expanding DD/Innovations waiver slots ($4.1M). The budget stipulates the following non-recurring dollars to go to: $2 million to case management, $5 million to group home funding, $5 million to substance abuse services. In the FY18-19 budget, the budget reduces single-stream funding by $36 million and redirects funds thusly: Local three-way crisis beds ($2.5M); Disability Rights Settlement ($6.28M); US DOJ/ Transitions to Community Living ($17M); Expanding DD/Innovations waiver slots ($8.26M), and reallocates non-recurring funds: $5 million to group home funding and $5 million to substance abuse services. All told, it’s a $32.7 millioin reduction in total funds in FY 17-18 for DMHDDSAS, and an $15.1 million increase in FY18-19. Moves $1.4M in single stream funding to Vaya Healthcare to pay for the initial startup of a crisis center in Wilkes County.
Orders reports from DHHS to include income and spending from the single-stream, I/DD and substance abuse services on the third Monday of each month.
Provides $10M over the biennium in supplemental funding for mental health group homes housing 6 or fewer people. Restricts who is eligible to receive these extra funds (continuation of “bridge” funding created in 2015) and also restricts the amount of payments to $464.30/ month. Also orders a DHHS report due in Sept. 2018 to: 1) list all the homes eligible for the assistance and 2) a plan for sustained funding beyond the 2017-19 biennium. Also see line 188.
Orders a review of DHHS’ Strategic Plan for Improvement of Behavioral Health Services and in there, orders the department to calculate quarterly a “solvency range” for each LME/MCO. This calculation should include: “incurred by not reported claims figure,” calculation of net liabilities, funds needed for catastrophic events, required intergovernmental transfers, projected operating losses and reinvestment plan amounts. Once this is done, DHHS is to compare the cash balances of each LME to the range described in the solvency report and adjust the budget accordingly.
Orders evaluation of the financial position of each LME-MCO. Stipulates that if the Secretary feels that the LME-MCO is at risk of failing in the coming biennium, DHHS officials need to meet with the LME-MCO, devise a remediation plan, and report to the JLOC on HHS. Also specifies what should be in an corrective action plan, schedules for reports, and sets out benchmarks for compliance. Amends language around the DHHS Secretary’s oversight of LME/MCO management and the creation of corrective action plans in the case of insolvency. Generation of quarterly solvency reviews to end in September, 2018.
Directs the use of funds appropriated in each year to increase the number of community hospital beds that can be used for mental health treatment (three-way beds), authorizes the use of funds for new and existing beds, and stipulates the use of the money (only buy bed time for indigent patients). Stipulates that 10 percent of total funds can be used for facility-based crisis services and hospital detox. It also sets the format for departmental reports to the legislature. House allocates $41.3 million in annual funds.
A 2015 plan began eliminating the state appropriation to the state Alcohol and Drug Abuse Treatment centers and changing them to only being supported by receipts. The plan phases down the state appropriation over a few years. This sets the threshold at 86 percent of the allocation to purchase services from the ADATCs in the 17-18 fiscal year. The remaining 14 percent of the LME money for substance use treatment can be used to purchase services from “any qualified provider.” Then decreases the amount required to be spent by LME-MCOs on the ADATCs by 10 percent / year until it reaches zero after FY 17-18. Also benchmarks those percentages NOT to the annual state appropriation, but to the amount calculated through this subsection.
Moves $17 million to DHHS from the proceeds of the Dix sale for the purpose of creating hospital-based psychiatric beds in rural counties: $4 million for Caldwell Hospital, $4 million at Mission Health, $4 million at Cape Fear Valley MC, $4 million at Vidant Health, $3 million at Good Hope Hospital and $2 million for the Dix Crisis Intervention Center in Onslow County. The total of the allocation for the beds is $17 million. Orders that all the beds be named in honor of Dorothea Dix. Unspent funds will remaina in the Dorothea Dix Hospital Property Fund Orders a report on how the funds acquired by the sale of Dorothea Dix Hospital property were used to purchase mental health beds in rural areas and three-way beds. Report should include the number of beds/ bed days purchased by the state and by LME/MCOs for people who were Medicaid indigent or who had no ability to pay.
Removes $10 million in one-time funding acquired by the sale of Dorothea Dix Hospital and puts it towards implementing the School Safety and Grants Program “mental health-related school safety initiative.”
Provides Certificate of Need exemption for the three-way beds noted above, and reserves 50% of the beds for use by LME/MCOs for individuals who are indigent or Medicaid recipients. Requires an annual report to the JLOC on Health and Human Services each Nov.
States the NCGA’s intent to set aside up to $2 milllion in one-time funding to pay for up to two new facility-based crisis centers for children and adolescents. Orders DHHS to create a process for applying for those funds, criteria for winning the grants, and allocation. Orders a study by DHHS on how to support these new beds into the future, to be delivered by December 2020.
Orders that any money left over from the Dix property sale not used to create new beds must remain in that fund.
Makes additions to the instructions given in the 2016 budget to DHHS around creating a statewide strategic plan for the improvement of behavioral health services. It requires DHHS to consider past studies and reports in the development of that strategic plan and orders the department to consider: why there is a growing waitlist for Innovations waiver slots and potential solutions to the growth of the waitlist; issues around single stream funding and how to use those dollars to support the I/DD population; any federal mandates that might impact services; coverage of services for people with autism.
Orders an additional $2 million to go to a pilot case management system at WakeMed designed to reduce emergency room boarding of behavioral health patients.
Appropriates $5.61 million in FY 17-18 and $5.66M in FY 18-19 to cover needs at state psychiatric hospitals, and also provides $1.2 million to account for inflationary increases on things such as drugs, food and utilities.
Appropriates $2.5 million in funding each year to pay for litigating the defaulted contract by the contractor building Broughton Hospital. It also provides $180,000 for a study around the future use of the old Broughton Hospital facilities and allows for the balance to be used for purchasing equipment and administrative costs incurred by the construction delays on the new hospital. Appropriates $5 million in recurring funds to create 169 full-time positions for the newly opening Broughton Hospital, finally becoming operational after multiple construction delays. Sets a limit of $19 million in annual operating costs and a total of $15.1 million of state dollars to be used for creation of 169 positions, costs for planning and moving patients from the old hospital to the new one, and operational costs at the new facility.
Appropriates $100,000 in annual funding to purchase the opioid antagonist Naloxone divided: $75,000 for the NC Harm Reduction Coalition and $25,000 to law enforcement agencies
Sets aside $2.4 million each year to be used to fund services for people with Traumatic Brain Injury, to be distributed as followed: $359,218/year to fund contracts with specific providers, $2.01 to support residential programs that are specific to people with TBI, and to support requests from TBI patients in the community who need things such as home modifications, transportation, etc. Provides $500,000 in additional, one-time funding for services for people with Traumatic Brain Injury.
Appropriates $150,000 for FY 17-18 and $300,000 for FY 18-19 to create and implement a traumatic brain injury pilot program to increase compliance with new evidence-based treatment guidelines to treat and maintain victims, while reducing long-term costs. DHHS will choose up to 3 sites at trauma hospitals, each will receive $100,000. DHHS will use recommendations created by the American Assoc of Neurological Surgeons in the pilots. DHHS will report to the JLOC of Health and Human Services by Jan 2019.
Orders the renaming of the Prescription Drug Abuse Advisory Committee to the Opioid and Prescription Drug Abuse Advisory Committee, adds a seat for someone from the Department of Public Safety.
Takes federal SAMHSA funds coming to North Carolina and allocates them for their use to combat opioid addiction. The money will be divided up: 80% per annum to be used to increase access to treatment and recovery services; up to 15% to increase access to prevention services and up to 5% to be spent on administrative costs.
Orders DHHS to increase the number of people receiving disorder treatment by 9% per annum and increases capacity of Medication-Assisted Treatment by 5% per year.
Orders a report to be delivered by DHHS on how the money was used, how many people were served, providers trained, outcomes and data on the providers of Medication Assisted Treatment services in each year.
Orders a study of provider prescribing practices and whether a continuing education class on best practices for controlled substance prescribing is changing practice. To be completed December 2017.
Retains funding for the Wright School and orders a study on expansion of the model in as many as two other sites. Orders a cost analysis for expansion of two Wright School expansions, one facility located west of I-77 and one located east of I-95. Analysis needs to include how construction and function of the facilities will impact Medicaid over three years with a focus on what would happen to inpatient hospitalizations, ED use, etc.
Orders a DHHS study of the use of site-of-use “solutions” for disposing old prescription drugs.
Eliminates a semiannual report created in the 2013 budget which had DHHS send to the NCGA about mental health integration activities between Community Care of North Carolina and Medicaid providers. Community Care is being deemphasized as the state prepares to move Medicaid to commercial managed care.

DIVISION OF HEALTH SERVICE REGULATION

DIVISION OF HEALTH SERVICE REGULATION
Provides money for additional staff for adult care home and acute care setting inspections, this will improve the timeliness of the inspections for many kinds of facilities, including hospitals, home care agencies, adult and family care homes and dialysis centers. The positions will help the state meet federal requirements for the number of staff to inspect facilities that are paid by Medicare and Medicaid. Amounts are for $372,380 of annual funds in FY17-18, bumped up to $729,667 in FY18-19, with $10,000 each year to set up the positions. By the end of the biennium, 14 new positions will have been added. Changes statutory language to allow for skilled nursing facility administrators to serve as adult care home administrator, so long as that person has been a SNF administrator for at least 90 days and passed a certification test for adult care home administrators.
Designates continued $350,000 in funding each year for pilot programs to expand the roles of paramedics and train them to appropriately divert behavioral health patients from emergency departments to community-based services, helping them “navigate” through the mental health system to find the services they need. Fund distribution: New Hanover Regional Hospital: $210,000; McDowell County Emergency Medical Services: $70,000; Wake County Emergency Medical Services: $70,000 Reduces agency budget by $366,029 in state dollars by eliminating 5 engineering/ architectural technician positions (and their fringe benefits) for positions that have been vacant for more than a year.
Appropriates $248,000 over the two-year budget to automate the background check system used by providers of long-term care services. It’s used check backgrounds of non-licensed staff (because licensed staff such as nurses, etc. go through background checks as part of their licensure) who provide hands-on care for patients/residents. The system was actually developed using federal funds and this money provides ongoing support.
Allows for hospitals to roll a shuttered hospital in a neighboring county into one license, so long as the closed hospital has been closed for fewer than three years and was the only hospital in operation.
Extends a moratorium on licensing “special care units” in adult care homes targeted toward people with Alzheimer’s disease until 2019. The moratorium does not restrict DHHS from moving the license from an existing facility to a new owner. It also allows for the HHS Secretary to issue a license for a unit in a county that’s been deemed to be a shortage area. Requires DHHS to submit a report on special care units to be delivered to the JLOC on HHS by March 2019.

DIVISION OF VOCATIONAL REHABILITATION

DIVISION OF VOCATIONAL REHABILITATION
Provides $100,000 in one-time funding to Cleveland Vocational Industries, a program that helps adults learn vocational skills and ready themselves to join the workforce.District represented by Rep. K Hastings, Sen. W Daniel

DIVISION OF MEDICAL ASSISTANCE

DIVISION OF MEDICAL ASSISTANCE
Instructs DHHS to reduce the overall spending on Medicaid by $30M over the biennium by finding reductions that can include contractual changes, rate reductions, different reimbursement methodologies, clinical policies, etc. These are called “flexibility” cuts, in that the Department has the flexibility to take the cuts where it can, but there is no flexibility on the amount.
Outlines Medicaid eligibility, which is adjusted to meet federal poverty level guidelines and stipulates the delivery of the annual Medicaid report. Codifies the provider application and recredentialing fee required every five years for providers who can accept Medicaid. Provides for the transfer of $1M per year to the N.C. Office of Administrative Hearings for remediation and other services related to the Medicaid appeals process. Patients who appeal decisions about their care made by Medicaid have recourse to the OAH for appeal. Sets out language for accounting for federal Medicaid receipts, volume purchasing and procurement policies.
Each year, legislators work with the Office of State Budget and Management to “rebase” Medicaid, that is, revise what the estimate is for the upcoming year’s spending. This year’s rebase adds $66.7 million of recurring expenses in FY17-18 and $177.4 million in recuring expenses in FY18-19, this allows for a 5.6 percent enrollment in the first year and 5 percent in the second year, plus anticipated changes in use of services. There’s also a $62.9 million reduction in one-time expenses in the first year, and a $64.8 million reductioon in FY18-19. These reductions represent federal payments the state receives as part of the ACA which provided additional funding for the State Child Health Insurance Plan (called NC Health Choice). That continues until September 2019. So, those funds are credited to Medicaid for each year of the biennium. No rebase in this year’s budget due to stated enough savings in the 2017-18 program to cover the difference between the budget calculated at the old federal match level of 67.61 percent and the 2019 match level of 67.16 percent.
Transfers $17.7 million in FY 17-18 and $18 million in FY 18-19 of funds back to the state from the LME-MCO system to cover risk reserve moneys paid on behalf of Medicaid patients who get their behavioral health care from the LME-MCOs. That care is paid for in a “capitated” flat rate. Some of that money is placed in a reserve to cover unexpected large expenditures. This provision remains similar, except the amounts that each LME-MCO transfers back to the state differs, even as the total remains the same, at $18,028,217
Moves money from LME/MCOs to the Division of Medical Assistance to reflect the fact that Columbus County has moved from Eastepointe to Trillium. No net change in funding.
Reduces the rebase for NC Health Choice (the State Children’s Health Insurance Program) by $44.4 million in FY17-18 and by $46.9 million in FY18-19, both in one-time savings to the program. This reflects federal receipts that came as a result of the Affordable Care Act and the fact that most Medicaid eligible children have been moved off of Health Choice and onto Medicaid to take advantage of better reimbursements. At the same time, the rebase does increase by $1.5 million in FY17-18 and by $3.9 million in FY18-19 in recurring funds. In sum, the expected total appropriatioon for Health Choice will be $459,248 in FY17-18 and $396,409 in FY18-19 because almost all of the children will be off of the program (these moves account for much of the increased Medicaid rebase). Health Choice rebase set at $2,823,341 in recurring state dollars and $313,635 in one-time dollars. This reflects movement of most children from the program onto Medicaid (see 2017 entry)
Requires DHHS to issue annual Medicaid cards and then requires DHHS to update rules to reflect that. One of the rules that will change in the coming year is the replacement of social security numbers on Medicaid cards with a unique ID number, which is a federal requirement.
Provides language to allow a person who receives services from an LME-MCO outside of his or her home county to easily have that service billed to their home LME-MCO. Prior to this language, patients had to travel “home” to receive services.
Adds 400 slots to the Medicaid Innovations waivers that support adults with intellectual and developmental disabilities, costing $2.58 million in FY17-18 and $5.1 million in FY18-19. Designates $125,000 in recurring funds to the NC Association of People Supporting Employment First to develop and roll out training programs to help create supported employment for pwople with serious mental illness, intellectual or developmental disabilities. The Department of Health and Human Services is to make these training programs available statewide to employers, service providers in LME/MCOs, etc.
Stipulates that money in the Medicaid Contingency Reserve (established in the 2014 budget bill) should only be used for Medicaid shortfalls. Sets out procedures for determining how to appropriate those funds when they occur.
Provides $1.5 million in one-time funding in FY 17-18 and $2.24 million in FY 18-19 for programming changes in NC Tracks, which is the Medicaid claims support and payment system. This will enable DHHS to make changes to the computer system such as clinical policy changes, and to make claims payment more efficient.
Orders enhancements to NC Tracks to prevent and detect fraud, waste and abuse. Any new capability for fraud detection should be made in the computer program within five months after the budget passes.
Designates a rate increase for workers providing personal care services for people eligible for Medicaid services. (This increase was included in the rebase, above.) The services include things such as help with bathing, dressing, eating, toileting, etc. The rate will go from $15.52/hour to $15.60/hour, costing an additional $1.3 million in FY17-18 and $2.7 million in FY18-19. Also in the rebase is an assumption of an increase in the number of hours between 7-10 percent. This increase is effective January 2018.
Orders DHHS to report to the JLOC of Medicaid and Health Choice on a plan for adding Medicaid coverage for ambulance transports of behavioral health crisis patients who are eligible for Medicaid away from emergency rooms and to more appropriate clinics or facilities. Plan is due by December 2017. Instructs DHHS to submit a waiver/ state plan amendment to the federal Centers for Medicare and Medicaid Services in order to receive Medicaid reimbursement for behavioral health crisis patients who are being transported to mental health facilities (not emergency departments). Lays out several contingencies (EMS has to demonstrate readiness, EMS system includes this in it’s state plan). Also requires DHHS to calculate expected costs, needs, reimbursement methodology, expected outcomes and savings, etc.
Provides for extra Medicaid reimbursement for 60 more physicians deemed eligible for the salary increase because they work in state backed faculty practices, such as UNC Health Care or ECU School of Medicine at a total cost of $3.2M, transferred from UNC and ECU to cover the costs. Orders DHHS to report to the legislature the allocation and distribution of these additional physicians receiving supplemental payment by Oct 2018. The last time the legislature added to this list was in 2014, this requires an adjustment to the Medicaid State Plan.
The budget reinstates $30 million in annual funding to maintain or continue graduate medical education payments, which are added onto inpatient hospital Medicaid payments. Medical interns and residents provide care to Medicaid patients even as they are being trained to become physicians and while it costs money to support them, they cost less than fully qualified and credentialed doctors. Mandates risk assessment of all the providers who are billing Medicaid or Health Choice. DHHS is to screen all new applications for physicians looking to be able to bill Medicaid and assessing them as “limited” risk, “moderate” risk or “high risk.” This section already exists in statute, but changes some of the designations, for example, for outpatient behavioral health service providers from high risk to limited risk.
States that it is the intent of the General Assembly to continue to fund graduate medical education, even as the Medicaid program transforms from fee-for-service to managed care. ORders a report by Jan 2018 on forecasted requirements for the graduate medical education budget, what are forecasts for Medicaid and what actions DHHS might be taking to keep Medicaid within budget.
Authorizes supervised preceptorship programs for chiropractic students and requires that students graduating from chiropractic programs meet accreditation requirements. Also requires that chiropractic assistants obtain a Certificate of Competency from the Chiropractic Board within 6 months of starting employment.
Makes technical and clarifying changes to facilitate the Medicaid transformation process. Stipulates services covered: Medicaid and Health Choice services, prescription drugs, long-term services and supports, behavioral services for Health Choice recipients. Also notes carve-outs from managed care, including: services documented in an Individualised Education Program provided by an educational agency and services directed by the CDSAs Appropriates $60 million from the Medicaid Transformation Fund to provide for the needs of staffing up/ IT/ ombudsman program/ provider credentialing, etc. in the runup to rolling out managed care in Medicaid. Allows for funds transfer of up to $192 million in spending to facilitate the transformation of Medicaid. Funds may be transferred as needed through the 2018-19 fiscal year.
Adds language to the Medicaid rules to add additional eligiblity monitoring for Medicaid recipients, requiring them to present qualifying information every quarter. This kind of documentation includes earned and unearned income, employment records, residency status, enrollment status in other state programs, death records, lottery winnings, etc.
Provides $103,784 in state dollars plus the federal matching funds ($207,568) to fund 4 positions to perform oversight and monitoring of a county eligiblity audit contract. Positions to start in Jan. 2019.
Orders DHHS to issue a report every March that details whether eligiblity determinations by counties is being done in a timely manner. This is in response to a state audit last year showing that many counties were not complying with federal guidelines for how quickly applicants were receiving their Medicaid and other social service benefit eligibility determinations. Originally, it was only a two-year report, but now will be ongoing. Orders DHHS to issue a report every March that details whether eligiblity determinations by counties is being done in a timely manner. This is in response to a state audit last year showing that many counties were not complying with federal guidelines for how quickly applicants were receiving their Medicaid and other social service benefit eligibility determinations. Originally, it was only a two-year report, but now will be every three years, at least, for each county.
Adds language from SB 546, which sets out a process for taking over a county social service department where Medicaid and other benefits eligibility determinations are too slow and not meeting state and federal timeliness guidelines. The Act would allow for DHHS to take over a county social service agency, implement a corrective action plan, and assume Medicaid eligibility administration until the county department can resume the services. Adds to this earlier language, language requiring that audits be performed on any county that has been taken over annually until the county/DHHS’s joint corrective action plan is completed. https://www.northcarolinahealthnews.org/2018/05/18/dhhs-takeover-child-welfare-cherokee-county/ Also requires an annual report of the number of counties audited, and their statuses.
Provides $256,802 in ongoing state dollars and the $800,000 in matching federal dolalrs to implement a contract (starting Jan, 2019) to audit county eligibility processes every 3 years. Counties with a corrective action plan will be audited annually until deficiencies are resolved.
Sometimes, when a resident enters long term care, they are not yet eligible for state-county special assistance. This extends the retroactive authorization period for SA from 10 days to 30 days, increasing the annual expenditure by $1.4 million in annual funds in FY17-18 and by $1.45 million in annual funds in FY18-19.
Requires DHHS to study the PACE program, similar to the study ordered in 2014, and requires an update to that info. Also orders an assessment of the state’s long-term needs for addressing the aging population and an evaluation on state regulations on PACE providers. The programs have been restricted in their ability to expand, and there’s been a moratorium on the development of new PACE programs. Requires DHHS to submit it’s study of expanding the PACE program by Dec, 2018 and report on: at least three plans for expansion, calculating the fiscal impact, the impact to underserved populations, analysis of potential care delivery options, analysis of potential savings, and other options for expansion.
Makes technical amendments to the new rules that will apply to new Medicaid “prepaid health plans.”
Sets forth language permitting the suspension of payment to Medicaid providers who may have been overpaid. Also allows the state Medicaid program to recoup overpayment by withholding further payment and makes technical changes to make this happen. Also makes changes to the review process for prepaying Medicaid claims. Orders DHHS to evaluate the management needs of the newly configured Division of Health Benefits, which will manage the Medicaid program once it converts to managed care. Any recommendations should include a transition plan that has a timeline in it.
Allows the new Division of Health Benefits to receive federal matching funds and prevents them from being moved to any other division of DHHS. The DHB will manage the Medicaid program once it is run by outside managed care companies after approval by federal regulators. Orders a forecast for Medicaid transformation as mandated in the 2015 law that ordered the conversion of Medicaid from fee-for-service to managed care. The forecast should include an annual budget with anticipated requirements, receipts and appropriations for each of the fiscal years, along with forecasted enrollment, forecasted claims costs, capitation rates, changes to utilization, changes to the federal matching rate, etc. and anticipated infrastructure to run the Division of Health Benefits.
Exempts employees from the Division of Health Benefits (which will managed the Medicaid managed care program) from the state Human Resources Act. Orders DHHS to “clarify the scope of authority” to define Medicaid program eligibility. Presumably, this is to prevent the executive branch from attempting to unilaterally expand Medicaid benefits beyond where they are at present. Also orders plan for winding down the work of the Division of Medical Assistance and launching the work of the Division of Health Benefits. Sets out that the General Assembly will be the body to determine eligibility, etc, for Medicaid and will be the body to define the goals of the program.
man stands at a podium with the state seal on it, flanked by flags,

Governor’s Health Care Budget Emphasizes Medicaid Expansion, Scaling Back Some Tax Breaks

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Governor’s Health Care Budget Emphasizes Medicaid Expansion, Scaling Back Some Tax Breaks - North Carolina Health News

Cooper's announcement is only the opening act in a multi-part annual budget process. Lawmakers have been crafting their own budgets ahead of next week's short legislative session.

By Rose Hoban

Even before Democratic Gov. Roy Cooper’s team was able to email out a laudatory press release touting “common ground” in his proposed budget for the coming fiscal year, leaders of the Republican-led General Assembly had emailed reporters their own release, rejecting the governor’s plan and calling it an “unserious attempt to score political points in an election year.”

Cooper’s $24.5 billion plan includes giving hefty raises to teachers and other state employees. And he calls for expanding Medicaid to cover many of the working poor, something that became an option under the Affordable Care Act (also known as Obamacare). Despite Congress’ attempts to undermine the law, the expansion remains an option.

About $1.4 billion in anticipated cost for the expansion would be revenue-neutral to the state, because hospitals and health care systems would foot the bill, according to state budget director Charles Perusse.

“The provider community who would get these additional federal receipts pulled down to provide health care, a portion of that would [go to] help us with the state match,” he said.

Cooper said he believed that the business community has come around to supporting expansion during this legislative session.

“I believe it will happen,” he said. “I hope it will.”

Work requirements

When asked if the governor would support the Carolina Cares bill, proposed last year by Republican members of the House of Representatives, Perusse said Cooper “would be open to any discussion to expanding health care and infusing the state with $4 billion of federal money.”

“We’re up to 32, 33 states that have expanded Medicaid,” Perusse said.

(According to the Kaiser Family Foundation, that number is currently 33 states plus the District of Columbia.)

“If you look at the detail, just as many are Republican states as are Democratic states,” Perusse said. “This is something that makes good economic sense for North Carolina.”

The Carolina Cares proposal includes a requirement that recipients who earn below 133 percent of the federal poverty level ($16,146 for an individual, $33,383 for a family of four) would need to be employed or performing volunteer work in order to qualify for assistance. People who are disabled, in school, performing caregiving duties or who are in substance abuse treatment would be exempted from the work requirement.

An issue brief published last year by the North Carolina Institute of Medicine noted about 60 percent of households that are uninsured and eligible for Medicaid under this expansion are already engaged in part- or full-time work.

“Some state House Republicans support increased access to Medicaid with a work requirement and although the Governor has serious concerns about that he’s pleased that there is some movement on this,” emailed Sadie Weiner, an aide to Cooper, when asked for clarification of the governor’s position.

But throughout the legislative interim, members of the state Senate have expressed their ongoing opposition to any attempts at expansion.

Opioid treatment dollars requested

Cooper also highlighted his proposals to add treatment capacity to the state to address the ongoing crisis of opioid use and overdoses.

“What I’ve heard across the state from law enforcement is that we need to keep going after drug dealers and the drug kingpins, but at the user level, we cannot arrest our way out of this problem,” he said. “They know that treatment is absolutely required to get us out of the grips of the opioid addictions that people have.”

man in a suit points at a large monitor displaying a spreadsheet of numbers
Budget director Charles Perusse outlined to reporters the changes in the tax code Gov. Cooper would like to see lawmakers make in order to pay for his priorities. Photo credit: Rose Hoban

The governor’s budget proposes an additional $9.8 million to support medication-assisted treatment, “on top of an additional $30 million of federal money that we already have for the opioid crisis,” Perusse said.

Additionally, the budget requests $11 million to go to Durham-based drug treatment program TROSA, and other programs which support people moving from addiction, through recovery and back into the workforce.

All told, Cooper asks for $25.7 million in appropriations, for mental health priorities, including funding for a suicide prevention hotline.

Part of that $25.7 million is almost $11 million to staff the newly completed Broughton Hospital in Morganton. Cooper’s budget also earmarks $3.2 million for a program to help people being discharged from psychiatric facilities transition back into their communities.

Smart Start, which provides a number of programs targeting 3- and 4-year-olds and their families with enrichment and early childhood education programs, would see a $15 million boost in the governor’s budget after years of being whittled away by legislative budget writers.

And the proposal would add $2.6 million to increase by 50 the number of people eligible for the Medicaid Innovations waiver program. This program allows for people with disabilities to receive substantial support services allowing them to remain in their homes and avoid institutionalization. Currently, there’s about a 10,000 person waiting list, which legislators reduced by 400 slots in last year’s budget for the same price tag.

However, funding for many of Cooper’s proposals, from teacher raises to recruiting additional nurses to the prison system, would require legislative action to slow down tax cuts enacted in recent years by the Republican-led legislature, something that seems unlikely.

When asked whether he expected a different outcome from last year, where the legislature largely ignored the governor’s proposed budget, Perusse worked to stay upbeat.

“We would hope that the investments in the governor’s budget would open the eyes of the legislature on the needs of the state,” he said. “We’re hearing from the business community and others that there might be some bipartisan support in several of these areas.

“This is always part of the process, the governor, the executive presents and then the legislature goes through their process,” he concluded. “Nothing different as far as that goes.”

illustration shows adults offering an obest baby french fries

Probing DNA to Prevent Childhood Obesity

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Probing DNA to Prevent Childhood Obesity - North Carolina Health News

N.C. State University scientist explores the link between a pregnant woman’s stress and her baby’s risk for extreme weight gain.

By Catherine Clabby

Frequent exposure to intense stress in childhood increases risks for several grave health problems throughout life; heart disease, diabetes, substance abuse, and depression are among the unwelcome outcomes.

But trouble from so-called “toxic stress” may start even earlier: in the womb, says Cathrine  Hoyo, a genetic epidemiologist at N.C. State University.

headshot of an African American woman.
Catherine Hoyo wants to make invisible effects from stress on human genes visible. Photo courtesy of North Carolina State University

With complex lab studies and questionnaires, Hoyo is probing why women who endure substantial stress while pregnant are more likely to have children who become obese.

Genetic changes that stressed mothers pass on to developing fetuses, may be in play, Hoyo says.

If she is correct, Hoyo hopes to help uncover a DNA fingerprint to identify children vulnerable to obesity, opening new doors to early preventative care by clinicians and families.

“If we’re going to intervene, we need to screen. To screen, you need to know what you are looking for,” Hoyo said.

Not just fast food and inactivity

In North Carolina, 13.5 percent of children ages 2 to 4 years enrolled in a federal nutrition supplement program were obese in 2016; 14 percent were overweight, according to the Centers for Disease Control and Prevention. Among those aged 10 to 17, 30.9 percent were overweight or obese, a slight dip from the 33.9 percent recorded in 2004.

chart shows prevalance of obesity among youth aged 2-19.
African American and Latino children are more likely to be obese in the United States. Source: Centers for Disease Control and Prevention.

Those tallies sound public health alarms because obese children are more likely to suffer breathing problems, including asthma, joint disorders and type 2 diabetes. They are also at heightened risk of becoming obese adults, who live with an elevated risk of developing heart disease, cancer and, with age, diabetes.

Not only is it expensive to treat such disorders, the illnesses often diminish a person’s quality of life.

“Obese children essentially have a permanent noose around their necks in terms of their future,” said Mary Jo Deck, a long-time child advocate who works with the obesity-prevention program ShapeNC at Buncombe Partnership for Children.

ShapeNC is among the programs in this state using science-based strategies to reduce excess weight in children by encouraging increased physical activity and switching from high-calorie processed foods to nutritious whole foods, including fruits and vegetables.

Hoyo, however, focuses on what most people could never see: biological alterations in miniscule stretches of the six feet of microscopic DNA tightly coiled inside human cells.

DNA carries the genetic code that children inherit from their parents; it’s the playbook that directs the specialized biochemical activities of our many specialized cells.

Hoyo studies epigenetics, the research field focused on how environmental triggers alter the activity of genes. Rather than rewriting DNA the way genetic mutations do, epigenetic gene regulation uses chemicals and proteins to activate or shut down genes or, sometimes, to blunt or rev up their activity.

Sustained and extreme stress are now recognized as environmental cues that can prompt epigenetic adjustments.

Surveys and sequencers

This summer, the National Institute of Minority Health and Health Disparities funded multiple research projects exploring the impact of “social epigenetics,” including an $800,000 annual award for five years to Hoyo. Such research is being pursued because some people, often poor people living in stressful environments, encounter more negative environmental triggers than others.

“Living in disadvantaged neighborhoods with exposure to chemical stressors, violence, discrimination, residential segregation and psychosocial stress, and limited access to healthy foods, can affect a person’s ability to stay healthy, becoming barriers to health,” the NIH announcement read.

NC Statistics show 30.9 percent of 10-17 year olds are obese in 2016, NC ranks 25th among states.
North Carolina childhood obesity figures. Source: The State of Obesity, by the Trust for America’s Health and the Robert Wood Johnson Foundation.

Hoyo’s laboratory team and research partners at Johns Hopkins University are recruiting hundreds of pregnant black, Latino and white women in North Carolina and Florida for their study.

They’ll ask the women detailed questions regarding the degrees of difficulties they live with. Queries will cover a woman’s use of drugs, physical activity habits and exposure to violence. They’ll ask whether family members throw things during arguments or strike one another, whether the women’s homes are in good or poor condition, and whether the water they consume is safe.

Eventually, they will study cells within their babies’ umbilical cords to see if they have been altered by high blood pressure and other physical responses to prolonged stress. They will also decode, or sequence in scientific language, regions of their babies’ DNA to look for epigenetic effects linked to high stress and obesity.

Through much of human history, the genetic regulation Hoyo wants to map could have been very useful. Having a child feel compelled to eat when not hungry could increase her chances of survival in places when food was scarce, for instance.

But that trait can be highly unhealthy today in the United States and other affluent countries among families when stress is abundant, and low-cost high-calorie food is only a fast-food drive-up window away, Hoyo said.

“The uterus is supposed to be preparing you for the outside world, but probably not the world we have now,” Hoyo said.

Eager for help

Ongoing efforts to change the quality of food available in day care centers and to encourage children to be more active have had positive impacts in North Carolina, Deck said.

Sponsored

Centers across the state participating in ShapeNC, for instance, have recorded gradual improvements in the weight of the children they care for along with more physical activity, more fruit and vegetables consumed and more outdoor learning.

The insight that a scientist such as Hoyo develops may help indicate which kids need special attention due to a physical predisposition to be obese and could help expand prevention. And prevention is always better than treatment.

“We’re picking up the pieces but we’re always behind,” Deck said. “Prevention puts us ahead.”

a little boy walks away from the camera with an enormous backpack on his back

Eliminating Pre-K Waiting Lists Proves a Knotty Problem

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Eliminating Pre-K Waiting Lists Proves a Knotty Problem - North Carolina Health News

Lawmakers promise to eliminate the waiting lists for North Carolina's state funded preschool program, but it's tougher than at first glimpse.

By Leah Asmelash

In each version of the North Carolina budget presented this year, from Gov. Roy Cooper to leaders of the Senate and the House of Representatives, lawmakers crowed about how they were chipping away at waiting lists for the state’s subsidized NC Pre-K program.

“Over the next two years, we’re adding $27 million to create an addition 3,525 new Pre-K  slots,” said House Appropriations chair Rep. Nelson Dollar (R-Cary) during a press conference to announce the final compromise budget between the two chambers of the legislature.

shows children playing with toy fruits and vegetables
Kids at a child care center participate in a “fruit lesson” to learn about healthy eating. Photo courtesy Wayne Community College Child Care.

“This will eliminate 75 percent of the current waitlist for at-risk children. And we certainly hope to continue to work on that, but this… this is the largest single investment I can remember addressing Pre-K children.”

But solving the waiting list problem for NC Pre-K may not be so straightforward. In conversations and emails exchanges with managers in more than a dozen of North Carolina’s largest counties, NC Health News found that different counties tabulate their waiting lists differently, so the same county may have a waiting list for part of the year but not the rest of the year and some counties simply turn people away without placing them on waiting lists.

It’s not just funds for Pre-K that keeps kids away. Long travel times and transportation issues limit access in some places. And the availability of the program can depend on whether more of a county’s programs are privately run or housed in elementary schools.

It’s hard to know exactly how big the waiting list for NC Pre-K actually is at any given time and whether the additional state dollars will solve the problem of 4 year olds missing their one shot at Pre-K because there’s no space for them.

Public & private

NC Pre-K is different from traditional pre-kindergarten programs in public schools. Eligible children must be 4 years old and must come from families whose income is at or below 75 percent of the state median income, $44,390 for a family of four. Placement is not guaranteed — hence the waiting lists.

The state doesn’t cover the entire cost of NC Pre-K, but instead pays a certain amount as reimbursement to those who provide the service. This year, the state budget allowed for $69.6 million in appropriations to cover the costs of NC Pre-K that came from the state’s General Fund. The rest of the $154.5 million required to cover the program comes from lottery proceeds and federal funds.

two little boys paint on easels while a woman with a identity tag looks on.
Preschools housed in elementary schools can apply for federal funding to help cover the costs not covered by state dollars. Photo credit: Shanna Trim, Flickr Creative Commons

Legislators applied $47.8 million from the General Fund in last year’s budget for Pre-K, this year’s appropriation is a $21.7 million increase over last year.

In a 2017 study done by the North Carolina Department of Health and Human Services, the average cost per slot in the NC Pre-K program is $9,126, of which the state covers 61 percent. The provider covers the remaining cost.

In the 2015-16 school year (the most recent year for data), more than half of the NC Pre-K providers were in a public school site (51.6 percent). Those sites have access to federal Title I funds, as well as other federal and state funding.

Private providers (32.9 percent) don’t have that luxury. Though their reimbursement rate is usually higher than their public counterparts, they are still left with a shortfall that can be met by funds from local Smart Start agencies or fundraisers. These options can vary by county.

“Private childcare sites have the biggest struggle in meeting their cost of care,” said Stacey Bailey, Buncombe County’s NC Pre-K program coordinator. “They don’t have any guaranteed additional funding streams.”

Funding that changes from year to year means the number of places in NC Pre-K that a county can fund changes every year, which affects the length of the waitlist.

In Mecklenberg County, 3,669 families who applied qualified for NC Pre-K, but the county could fund only 1,006 spaces. In Alamance County, over 600 families have applied for NC Pre-K already, with months left in the application period, but county officials can fund only 426 children. In Catawba County, there are an estimated 1,100 eligible kids, but they can fund only 322 spots.

All the counties mentioned have a waitlist.

The number of kids on a county’s waitlist isn’t static, it’s something that fluctuates frequently over the course of a year, managers in all those counties said.

Getting there is half the battle

Victor Coffenberry, Pitt County’s NC Pre-K program director, said transportation, or lack thereof, has a great impact on waiting lists.

“We don’t provide transportation,” he said. “So when you’re looking about placing a classroom somewhere, you have to look about, ‘Okay where do I have children where the parents can get them to that location?’”

“That’s difficult.”

Coffenberry said there are lots of things that determine the length of a waiting list. Parents move away, or their car breaks down and children can’t get to Pre-K anymore, so they take children off of the waitlist.

Transportation is a major challenge for families in Buncombe County as well, said Bailey.

“For public schools, transportation is embedded in their program, for private child care providers, it’s not necessarily embedded to their program,” she said. “So families who want to come and participate in NC Pre-K, they have to be able to drive their child and drop them off in the morning and pick them up at the end of the school day. And for some families, if they only have one car for instance, that can be a struggle.”

Especially if their car needs maintenance or repair and the family doesn’t have the means to take care of it, Bailey said.

And since the cost of NC Pre-K isn’t completely funded by the state, that third of providers that are private organizations simply cannot fund transportation.

Nearly all of the county managers said there’s almost always children left on the list at the end of the year, all 4 year olds who missed their one shot at Pre-K. .

As far as program expansion goes, Coffenberry said the process of pulling together more resources – teachers and classrooms – takes time to plan, and may not be ready as soon as the government gives them money, especially if the state dollars land in the bank closer to the school year.

“I’d hate for a rush of people,” he said. “Everyone’s showing up saying ‘Oh, you’ve got expansion, you should be able to place all the kids, where’s my spot?’ And, you have to say, ‘Well, it’s not that easy.’”

Susan Gates, an education advisor with the SAS Institute, said she’s pleased with the state’s efforts to decrease the waitlists, but there’s still work left.

“Over 33,000 children across the state who are eligible for the program will still not be able to access it,” she said. “Not every county keeps a ‘waiting list,’ and many families may not apply if they believe there will not be space for their child.”

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