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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.
an older woman holds up a folded over document and looks off camera as others look at her.

State Budget’s Potential Winners and Losers Were A Mystery Before This Week

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State Budget’s Potential Winners and Losers Were A Mystery Before This Week - North Carolina Health News

Usually, legislators create a draft budget that’s subject to changes and tweaks. But this year, members of the Republican majority crafted a final budget that will receive an up or down vote later this week.

By Rose Hoban

Lobbyists, health care advocates and lawmakers alike spent much of Tuesday poring through hundreds of pages of legal language after the Republican majority members of the General Assembly posted their proposed $23.9 billion state budget online late Monday night.

Members of the Democratic minority criticized Republicans for this year’s unorthodox bill drafting process. Previous years have featured committee hearings, amendments and multiple versions of the budget in a process that gives advocates and other legislators opportunities to plead for funding and point out inconsistencies.

This year, however, that process was largely absent. Instead, the more than 700-page budget was crafted almost completely behind closed doors.

All told, Health and Human Services will receive about $5.3 billion in mostly Medicaid spending but will see a trim of about $37 million from what was allocated last year.

Read the budget documents for yourself!
Senate Bill 99 – which includes any policy changes
Conference Committee Report – many line items are noted here

The process did produce some benefits for dozens of not-for-profits around North Carolina which received mostly surprise allocations of state dollars. But there were unpleasant surprises too, for leaders of the state’s publicly funded mental health agencies, which faced cuts in dollars to pay for indigent mental health patients.

shows a man in a suit and glasses speaking, looking off camera.
House Speaker Tim Moore (R-Kings Mountain) defended the use of earmarks and his party’s process for compiling this year’s state budget. Photo credit: Rose Hoban

And a couple of things were overlooked, such as funding for a suicide hotline, in the rush to produce a budget, write a few bills and recess the short legislative session before the end of the state fiscal year on July 1.

First, the good news

The Health and Human Services section of the budget contained pages of earmarks benefiting select not-for-profits such as food banks, domestic violence shelters, free clinics and more, totaling close to $6 million. Appropriations ranged from $7,500 for the Make a Difference food pantry in Mt. Olive, which is represented by Senate Health Care Committee co-chair Louis Pate, to $750,000 for the Children’s Center of Surry, in the district of Rep. Sarah Stevens (R-Mt. Airy), who has been active in writing legislation to overhaul the state’s child welfare system.

“We ask members if they know of any particular projects in their districts that they think are in need of state support,” said House Speaker Tim Moore (R-Kings Mountain). “They submit those requests and they go through those and we try to fund as many of those as we can.”

But Democrats decried the spending as “pork,” where lawmakers can allocate state spending to pet projects at home to bolster themselves in a tough election cycle.

“I know it, I can smell it,” quipped Democratic House leader Darren Jackson (D-Raleigh) during a press conference.

“We don’t call it pork anymore, we call it ‘member money,’” he said in a sarcastic tone.

But when asked, Moore defended the practice, which was common when Democrats controlled the legislature.

“Certain members who were involved in the budget drafting were given so much money that they could spend in ways they saw fit and so that money has made it into non-profits and things across the state,” he said.

“[Lawmakers] get a lot of appreciation from the folks back home, and it’s money being well spent.”

End of a long process

One spending line that came as a pleasant surprise went to the Durham-based substance abuse treatment program TROSA, which received $6 million in state dollars to help with opening another facility in the Triad.

“Forsyth and Guilford are two of the most-served counties for TROSA right now,” said Keith Artin, TROSA’s chief operating officer. “We’ve been working for a while and looking for awhile at the possibility to create a satellite campus so we can more effectively serve more people.”

Artin said his organization has been making its case at the legislature for several years, as the state’s opioid crisis has deepened.

But he didn’t know if state lawmakers would allocate any money, even though Gov. Roy Cooper had set aside $11 million for the organization in his budget. Many of the governor’s priorities have fallen by the wayside amidst Raleigh’s political wrangling and Artin worried that funding for their expansion would be one of them.

Instead, he received a text from their lobbyist Monday evening saying that the budget was online. “And then I got one from a friend who pays attention about a half hour later saying that TROSA was in the budget,” he said. “As recently as a week ago, I would have told you we weren’t going to get anything.”

Now Artin said the real work begins of making their second facility a reality. The state money will give them a boost as they fundraise from private donors and businesses. He said Blue Cross and Blue Shield of North Carolina has already pledged an additional million.

“The budget for this expansion was originally estimated to be something much bigger… but this is a pretty important part of the puzzle, for sure,” he said. “I think we’ll come up with something that’ll really make an impact.”

And the bad news

Leaders of state-funded mental health managed care organizations (known as LME-MCOs) expressed resignation to learn that state funding to cover services for people who are uninsured had been cut for the fourth year in a row.

This so-called single stream funding has been a bone of contention for lawmakers who have criticized the LMEs for holding onto too many state dollars instead of spending them on developing new services.

One of those services, a mental health crisis center in Wilkes County had been put on hold by Vaya, the LME-MCO for the westernmost part of the state. So, legislators made their wishes known by appropriating $1.4 million to cover the initial costs of the center, and Vaya’s $5.5 million cut to single stream funding shrank to become a $3.8 million cut.

“We’re pleased to see that crisis center funded because it’s a high priority project for us that has been in the queue as part of our community reinvestment plan,” said Vaya head Brian Ingraham. He said his organization has developed two other crisis facilities but had put planning for the Wilkes County center on hold after last year’s cuts.

Ingraham said the new dollars would go a long way to standing up the new center, but he wasn’t sure how to pay for ongoing costs which he estimated at between $1.5-$2 million a year.

“We know that the vast majority of individuals who use [crisis centers] do not have Medicaid,” he said. “That money comes from single-stream dollars and the challenge there is that money is extremely tight, so we’d probably have to look at the budget again.”

“Figuring out how to make it all work and sustaining it, that’s the real art to it,” he said.

screen shot of budget document
Screen shot of the LME-MCO single stream funding cuts in this year’s state budget.
Waynesville Police Chief Bill Hollingsed takes a proactive approach to opioid addiction and overdose in his community.

Opioid Epidemic Inundating Public Health, Foster Care Systems

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Opioid Epidemic Inundating Public Health, Foster Care Systems - North Carolina Health News

A forum in western North Carolina last week examined the effects of the ongoing addiction and overdose crisis in that part of the state.

By Michael Gebelein

Carolina Public Press

If you think the “opioid crisis” has been overhyped, consideration of the facts discussed at a forum on opioid issues in Asheville last week may change your mind.

Deaths from drug overdoses in North Carolina surpassed deaths from motor vehicles accidents for the first time in 2010.

Emergency room visits and hospitalizations related to opioid overdoses have skyrocketed since the early 2000s, with the most recent data from the North Carolina Department of Health and Human Services showing that emergency room visits for opioid overdoses have doubled since 2009.

The foster care-system in North Carolina has become inundated with children who are removed from their parents’ home because of substance abuse problems, with drug abuse listed as a factor in nearly half of all out-of-home placements in 2016.

The over-prescription of opioid painkillers coupled with the increasing availability of heroin and fentanyl on the streets has led to more than a quarter-million deaths in the past 10 years across the country.

Dr. Blake Fagan, chief education officer at the Asheville-based Mountain Area Health Education Center, made these points during his keynote speech Tuesday at the N.C. Community Association’s opioid forum, where health-care providers, public-health experts, law enforcement officers and emergency responders came together to discuss the state’s opioid epidemic and the many ways state and local agencies are working to address the issue.

Fagan said the opioid crisis has hit the Appalachian mountain region particularly hard, with overdose death rates at more than 50 percent higher than the rest of the country. Public-health programs like needle exchanges and the availability of the overdose-reversal drug naloxone have likely saved lives and slowed the spread of communicable diseases, according to NCDHHS statistics, but opioid-related deaths, particularly the percentage of those deaths involving heroin and fentanyl, continue to represent a major public health crisis.

Other participants in the forum concurred, adding direct observation and experiences to the statistical data.

Jan Shepard, the public health director for Buncombe County, said during a panel discussion that her agency has seen “alarming increases” in overdose deaths, and said the county could see a four-fold surge in those deaths in 2018, compared to 2016.

She also said her agency has significant concerns about substance abuse and its correlation with infant mortality and prenatal health, as well as increases in Buncombe County in rates of HIV and Hepatitis C infections.

Barry Hendren, the assistant fire chief with the Asheville Fire Department, and Bill Hollingsed, chief of the Waynesville Police Department, described new emergency services programs that provide resources and support to drug users, either after they’ve committed a crime or have been treated for an overdose.

In Waynesville, the police department is implementing the “Law Enforcement Assisted Diversion” program, where drug users accused of some crimes are offered a spot in a treatment program rather than being taken to jail.

“L.E.A.D. actually diverts that individual from the court system,” Hollingsed said. “Initially, if we have an officer who comes across someone in the community who may be possessing a small amount of drugs or involved in low-level crimes to support their addiction, instead of putting them back into the court system, for the fifth, sixth, seventh, dozenth time, with no real clear results, we will divert them from the court system and put them into treatment.”

Jesse Smathers, specialty populations director for Vaya Health, the managed care organization that oversees publicly funded mental-health services in Western North Carolina, described several measures Vaya is undertaking to better understand how to respond to the opioid crisis.

“Vaya is required to do a network adequacy plan … that’s specific to mental health, substance use and intellectual and developmental disabilities services,” Smathers said. “All of that information is compiled in our network development plan which, in the past, has led to an increase in the number of opioid treatment programs we contract with and other services.”

Last week’s forum was sponsored by Public Media North Carolina, MAHEC, Mission Health and Carolina Public Press.

Audit Finds High Salaries, Generous Severance for Mental Health Executives

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Audit Finds High Salaries, Generous Severance for Mental Health Executives - North Carolina Health News

A new report details juicy salaries paid to some top employees of Cardinal Innovations, one of the state’s mental health management organizations.

By Rose Hoban

A new report from the state Department of Health and Human Services finds salaries, bonuses and severance packages for top executives at one of the state’s mental health managed care organizations are “excessive” and out of compliance with state guidance.

The DHHS Internal Auditor report follows a scathing May report by the State Auditor of Charlotte-based Cardinal Innovations, which manages mental health services in 20 counties, overseeing services for as many as 850,000 Medicaid recipients.

headshot of Cardinal CEO Richard Topping.
Cardinal CEO Richard Topping. Image courtesy Cardinal Innovations

Late last year, legislators excoriated Cardinal CEO Richard Topping during an oversight committee hearing where it was revealed Topping was eligible for as much as $1.2 million in salary when bonuses and an annuity were added in.

In the wake of that revelation, Topping’s salary was limited to $617,000 for 2016.

Even still, “the salary and bonus opportunities for Cardinal’s CEO are more than three times higher than those of the CEO’s at the State’s six other LME-MCOs,” Monday’s report reads. “Additionally, compensation for Cardinal’s CEO is three times higher than the maximum allowable for the position established by the North Carolina Office of State Human Resources.”

The other six LME-MCO chiefs in North Carolina have salaries ranging from $175,000 to $217,155 last year.

The report reveals that Topping’s contract includes a severance package that runs for at least two, and up to three years if he is terminated.

The report also detailed how the top 10 other employees beyond Topping had their employment and severance tied to Topping’s, with a poison pill inserted in each of their contracts: If Topping is fired, or if the state were to take over Cardinal, generous, long severance packages would kick in for each of those 10 executives.

“We stand by the legality of our market-based employment practices, which have been in place without issue for 23 years,” wrote Cardinal spokesperson Ashley Conger in response to a query.

“Substantially equivalent”

Cardinal officials have long argued that their agency does not have to abide by rules that dictate compensation and administration of state employees.

Table courtesy NC DHHS

“Cardinal received approval from the state to leave the state personnel system more than 20 years ago,” reads part of Cardinal’s three paragraph response to the DHHS audit, which was signed by Lucy Drake, the chair of Cardinal’s board of directors. “As a result, Cardinal’s employees are not part of the state pay scale, do not receive state benefits and are not part of the state retirement program.

“We adopted market-based employment practices to attract and retain well-qualified staff so that we can continue to deliver high-quality outcomes for members and maintain their service continuity while the State completes its efforts to reform the Medicaid program.”

Table courtesy NC DHHS

But the DHHS auditor specifically rebutted Cardinal’s assertion, noting that “six of seven LME-MCOs in North Carolina have received approval for ‘substantial equivalency’ in Recruitment, Selection, and Advancement… and Classification/ Compensation,” in accordance with the law. Further, the auditor argued that despite Cardinal being designated “substantially equivalent” in 1993, and had several more recent reviews, Cardinal did not comply with ongoing requirements to recertify its status, nor did the organization keep up with required documentation.

Dave Richard, the state’s Medicaid head said such compensation and severance packages are “not the norm for public entities,” but admitted that the state’s hands are tied when it comes to disciplining Cardinal, Topping or the organization’s board.

In front of PBH's Kannapolis office.
In front of Cardinal Innovation’s Kannapolis office, which was the corporate headquarters until they were moved to Charlotte. Photo credit: Lydia Wilson for NCHN

“We don’t have a specific actionable step that is outlined in law that allows us to take a specific action that we would like to take,” Richard said.

“But I think there are significant amount of other options to address in terms of the way that we negotiate and work with our contracts going forward with other organizations.”

Public money

Cardinal has also argued in the past that under Medicaid rules, the organization is permitted to retain any savings to use as it sees fit. Technically, Medicaid rules allow that to happen, but when lawmakers established the LME-MCO system, it was with the intent that savings would accrue back to the state.

Botts headshot
Mark Botts, UNC School of Government

In an interview this spring he was unequivocal.

“Cardinal’s money is public money,” Mark Botts, from the UNC School of Government, wrote in an email this spring.

Botts is an attorney who studies the state’s mental health system, and he argued “the vast majority of [Cardinal’s] revenue is either county, state, or federal money (county appropriations from the county general fund, state appropriations from the state general fund, or Medicaid and federal block grant money that is also appropriated through the state budget).

“It is possible that a tiny fraction of Cardinal’s revenue may come from private grants or client fees (non-public sources), but once that money is received, it has to be accounted for and spent in accordance with the Local Government Budget and Fiscal Control Act,” he said.

Botts also pointed out that statute requires that Cardinal’s board of directors “obtain prior approval for any salary that exceeds the salary range established by the state for LME-MCO directors.”

The audit argues that didn’t happen.

Powerful allies

In March, House lawmakers in the General Assembly moved to rein in Cardinal’s spending, moving a bill that would have set a specific cap on LME-MCO salaries.

But Cardinal has powerful allies in the Senate and influential lobbyists on its payroll. In 2016, the organization spent $207,000 on one lobbyist, Joe Lanier, while other LME-MCOs spent, on average, $78,900 on lobbyists.

Image shows reporter with a laptop sitting alone in the press area of a committee room.
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In 2017, Cardinal beefed up its lobbying capacity, adding four additional lobbyists to Lanier. One of those is Tom Apodaca, who, until summer 2016, was the second most powerful member of the Senate. Public spending disclosure forms for 2017 have not yet been filed. The organization also hired former Republican House lawmaker Rob Bryan to be the chief development officer, and current Senator Joel Ford (D-Charlotte) is a vice-president with the organization.

In June, members of the Senate gutted the bill and replaced the restrictions on Cardinal with language that would completely overhaul the state’s mental health system within two years.

The bill stalled when House leadership objected to the changes.

That leaves decisions about curbing any contract excesses to Cardinal’s board of directors.

Richard said he believed the board would have “ample opportunities to make the right decision,” and officials from DHHS have asked to meet with the body. No date has been set.

But Cardinal’s board may have its hands tied too. Those contracts described in the report allow for the top 10 executives to leave and begin drawing generous severance packages if Topping were to be fired or if the state were to attempt a takeover of the organization.

That would leave the board with a dilemma as well: If executives who have contracts tied to Topping’s presence were to follow him out the door, the organization could be rendered leaderless, even as Cardinal would be compelled to pay out millions in salary for people who are no longer there.

Local Municipalities Feel Effects of Mental Health Cuts

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Local Municipalities Feel Effects of Mental Health Cuts - North Carolina Health News

Wake County commissioners heard about how cuts to mental health funding at the legislature will have effects in the Triangle.

By Thomas Goldsmith

Like many hospitals across the state, emergency departments in the Triangle continue to deal with large numbers of patients who have been involuntarily committed and have no place else to go.

But in counties around Raleigh there’s a twist to the longstanding problem — state cuts that put a halt to the opening of a center dedicated to better treatment for patients in crisis.

More than 100 such involuntary commitment patients showed up on a recent Monday at WakeMed Hospital in Raleigh. The deluge of mental health patients resulted in WakeMed putting itself on “diversion,” where the emergency department closes for all-comers.

“That’s a serious condition when you have your hospital compromising services.” County Manager Jim Hartmann said.

“Our ERs have a large number of mental-health related patients and limited resources to deal with them,” Denise Foreman, assistant to the Wake County manager, told a packed work session of that county’s Board of Commissioners recently.

Alliance Behavioral Health, the local mental health management organization (called LME-MCO) for Wake, Durham, Johnston and Cumberland counties, initially got heat from local officials at the meeting. They had been anticipating an opening this year of a 16-bed adult crisis center at WakeBrook, a behavioral-health facility near WakeMed that’s managed by UNC HealthCare.

But Alliance and other North Carolina LME-MCOs have lost tens of millions from the state in single-stream funding, or money that covers services that Medicaid can’t pay for. The funding also pays for care for people with disabilities who might be uninsured and who also don’t qualify for Medicaid.

“The Adult Crisis Center is now on hold,” Board of Commissioners Chairman Sig Hutchinson said to Rob Robinson, Alliance CEO since 2014. “You’ve got enough money to fund it for two years.”

Operating the clinic would cost $6 million annually, and Alliance officials say there’s no guarantee that the funding would sustain it longer than a couple of years.

“We could probably get it up and running for two years, then we’d have to close it,” Robinson said.

In an interview with NC Health News in June, Robinson said the center “was designed to help primarily the un- and underinsured who are now sitting in many of our hospitals and who are waiting.”

Page 189 of the final state budget bill shows cuts for each of the state’s LME-MCOs.

Alliance is not the only LME-MCO struggling in the wake of legislative cuts to single-stream funding: Cardinal Innovations, which manages behavioral health care for people in a number counties, has been passing funding cuts on to behavioral health contractors; Vaya Health passed on cuts to providers of vocational training for people with intellectual and developmental disabilities in Wilkes County.

All told, the state budget cuts the single-stream funding paid to LME-MCOs by a total of $31 million annually and by $55 million in one-time funds in FY 2017-18 and by a total of $36 million in annual funds and by $54.6 million in one-time funds in FY 2018-19.

Nonetheless, legislators ordered the LME-MCOs to maintain the same level of service provision as during the past fiscal year.

photo shows NC House Speaker Tim Moore takling to media surrounded by repoters and cameras on Aug 3, 2018

Most Mental Health Management Organizations to See Additional Trim

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Most Mental Health Management Organizations to See Additional Trim - North Carolina Health News

Lawmakers were alerted there was a miscalculation in how they tabulated cuts made in June's state budget. As a result, most agencies saw their cuts increase.

By Rose Hoban

Even as North Carolina’s mental health management organizations are adjusting to cuts to their budgets ordered in this year’s state budget, most of the organizations experienced another trim Thursday.

That was the day that legislators came back to Raleigh for what was originally billed as a one-day session to override gubernatorial vetoes. But not enough members of the majority made it to the capital, so instead the session became about passing up some unfinished bills from the regular session and making adjustments to the state budget.

Included in House Bill 770, approved by both chambers on Thursday, was a provision cutting $4.8 million in recurring funds, plus $2.5 million in one-time funds from six of the state’s seven mental health management agencies over the next two years. That money will be transferred to Partners Behavioral Health Management, the seventh of the state’s management organizations.

Partners manages mental health services for people in eight counties in the foothills of the Appalachians stretching from the South Carolina to the Virginia borders. According to Medicaid head Dave Richard, from the Department of Health and Human Services, when lawmakers made funding cuts to all seven mental health management organizations (known as LME/MCOs), they miscalculated and cut too much from Partners’ budget.

So they had to make it up by taking money from other agencies.

“The legislature made the calculations on how they would do that cut,” Richard said. “Partners alerted us, I think a week and a half ago, that was the case and they had been in conversations with the General Assembly.”

Adjustments on top of adjustments

Richard said people from DHHS have been helping all of the LME/MCOs adjust to this year’s cuts.

“The department’s position will continue to be that you have to follow the law,” Richard said. “Obviously, we want to have the least disruption as possible for populations as you’re following that law.”

Screenshot of the parts of HB770 which detail the adjustments made on Aug. 3, 2017. Shows additional cuts to Alliance, Cardinal, Eastpointe, Sandhills and PartnersHe said he’s been encouraging LME/MCOs to find creative ways to address the cuts they already have and will have to encourage more creativity to adjust to the new trims.

Screenshot of the parts of HB770 which detail the adjustments made on Aug. 3, 2017. Shows additional cuts to vaya and Trillium
Screenshot of the parts of HB770 which detail the adjustments made on Aug. 3, 2017.

“The Governor’s budget was pretty clear about what we thought about those reductions,” Richard said, “to restore all of them and use some of that restoration to actually leverage additional federal money to address some of the waiting list issues around developmental disabilities.”

He said his agency had nothing to do with making these further cuts.

“We assumed it was something that would happen, but didn’t have specifics of what the formula would look like and what the changes would be,” Richard added.

Legislative leaders said the need for the adjustment was the result of a miscalculation. Cary Republican Rep. Nelson Dollar grimaced when asked about the additional cuts.

“It was truly a technical adjustment,” Dollar said. “It may not feel technical in the field because you’re moving money around, but it was miscalculations that were done in the allocation.”

He explained there was a per person formula that guided legislators’ calculations, and someone made an error.

“I’m sure everybody will be understanding… well, understand that those things happen, that we have to make adjustments,” he added.

Already tight

But Leza Wainwright, from Trillium Health Resources in the eastern part of the state, said it was a problem for her agency.

“We have already issued our contracts for the fiscal year based upon the budget enacted by the General Assembly on June 28 and our budget was already extremely tight,” Wainwright wrote in an email.

“Our board is still pondering how to deal with the previously approved level of reductions in terms of our planned reinvestments and this will just make those decisions that much more difficult.”

She also said her agency had not yet received the first month’s funding of the money they were allocated, “so this additional drain on reserves makes cash flow even more challenging.”

House Speaker Tim Moore (R-Kings Mountain) said there was an outcry about the fairness of one agency receiving a larger per capita cut than others. When asked whether it mattered that Partners covers Cleveland County, Moore’s home base, he said that didn’t factor into the decision.

“I can tell you this that if that had happened in eastern North Carolina I’d be one of the first in line saying, that needs to be fair,” Moore said.

What a long, strange trip

House Bill 770 was originally a bill about regulation of underground storage tanks. In late June, it was sent to a Senate committee where it transformed into a bill rolling back a number of environmental regulations, some controversial. As the regular legislative session ended, the House and Senate could not agree on the measures in the bill and it again disappeared into a conference committee.

Once a bill goes to conference committee, members hash out the details, and when it’s done it only faces an up-or-down vote in both chambers, no amendments allowed.

When the bill emerged Thursday, it had morphed into a laundry list of “clarifying” changes to a number of measures from schools, to property tax commissioner salaries, to changing appointments to the state’s Medical Board.

Included in the now-9-page bill were the budget adjustments for the mental health organizations.

Not quite Schoolhouse Rock.

Correction: This story has been changed to correct the name of Partners Behavioral Health Management, which we originally called Partners Behavioral Healthcare.

 

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