More North Carolina Budget Woes

At the end of the legislative session, state budget writers went from debating a zero to 10 million dollar cut, to taking a 20 million dollar cut out of state funded services for people with developmental disabilities, mental illness and addictive disease. While it is the same cut as last year, it has much greater impact. Local Management Entities (LMEs) are not required to use their fund balances to cover this cut. Most have used their fund balances to prepare for managed care changes and to fund last year’s funding cuts.

In addition, after Legislators finished their session and went home, advocates and LMEs discovered that Legislators had changed the allocation of block grant funds. $8.6 million was to be used for developmental disability services, including $4.3 million which was moved to be used for much needed guardianship services. The remaining 4.3 million was “accidentally” removed and distributed to other areas of the block grant budget.

All of this has resulted in a loss of $24.3 million in funding, mainly for services for people who do not have Medicaid or other health insurance. Reports have begun coming in from regions across the state of cuts in adult vocational services funding and proposed cuts to provider rates. Centerpoint LME issued a statement that they will take $1.7 million in service cuts, including a $633,474 cut to services for people with intellectual and developmental disabilities. Many other LMEs are meeting to discuss what service cuts will result from this loss of funds.

Problems with managed care are taking their toll on funding as well. Centerpoint has asked for $1.53 million in funds from its counties to support the managed care conversion, and Western Highlands, who converted to a managed care model in January of this year, has reportedly been spending $500,000 a month which has resulted in a $3 million dollar deficit in their budget. The Western Highlands CEO was fired and the Board and management  of Western Highlands are now considering 30% rate cuts to providers or other cuts to bring their budget back in line. Many advocates are concerned that drastic rate cuts will force providers to close their doors and cut off access to services or that “efficiencies” to be found mean cutting service hours or whole services.

Every LME and every county will eventually be impacted by the $24.3 million in cuts. The Autism Society of North Carolina asks that you talk with or write to your legislators about service cuts in your region and let us know if you have been directly affected by these cuts. Telling your story is an effective way to get your message across. The legislative oversight Committee on Health and Human Services will meet Tuesday, August 14^th, from 10 AM to 3PM in the Legislative Office Building. We hope to hear of their plans to fix the $4.3 million dollar mistake and what they intend to do to ensure that people do not have services cut.

If you have questions about the budget cuts or other public policy issues, contact Jennifer Mahan, Director of Government Relations for the Autism Society of North Carolina, Jmahan@autismsociety-nc.org or 919-865-5068.

Time is Running Out for Feedback

[Note: this alert was also sent out to the Autism Society of North Carolina's network of subscribers on June 8th, 2012]

 

Time is running out to make your voice heard on the managed care system in North Carolina! The Autism Society of North Carolina, in collaboration with the Arc and other Developmental Disability Advocates, have made recommendations to legislative leadership to improve the managed care system created with House Bill 916 last year. The best way for you to help move these proposals forward is through grassroots contact with lawmakers.

 

The current managed care plan needs changes to meet the needs of people with developmental disabilities, including autism spectrum disorder. The plan needs to:

• Allow for an Independent Care Coordinator so that individuals have someone other than the Managed Care Organization develop the person-centered plan and link to appropriate services.
• Ensure that if an individual has CAP I/DD their slot is portable so they can move within the state without his/her services interrupted simply because of where his/her Medicaid was first established.
• Ensure stakeholders, especially families and individuals, are involved in managed care implementation and oversight.

Legislators have been listening, and we believe they want to fix these issues, but they need to hear from you, their constituents, that you want this to happen!

Tell your legislators that:

 

You support changes to HB 916 (last year’s HB 916 is also known as SL 2011-264: Statewide Expansion of the BC Waiver)

 

Then use the bulleted talking points above in your phone call or email. Briefly tell your story about how autism spectrum disorder is impacting you and your family. Emails will make a difference, but phone calls have even more impact!

 

Please contact:

• NC House Speaker Thom Tillis, Mecklenburg County, Thom.Tillis@ncleg.net or 919-733-3451.
• NC Senate President Phil Berger, Guilford and Rockingham Counties, Phil.Berger@ncleg.net or 919- 733-5708.
• Your Own NC State Legislator,  If you don’t know who represents you, look them up online on the NC General Assembly Web site here.

 

Thank you for taking action on this critical issue. If you have questions about this alert, other policy issues that impact autism, or need help looking up your Legislators, please contact Jennifer Mahan, Director of Government Relations, Autism Society of North Carolina, 919-865-5068 orjmahan@autismsociety-nc.org.

Coalition Rally 2012

Mark your calendars now and join The Autism Society of North Carolina (ASNC) at the for the 2011 Coalition Popcorn Rally and Advocacy Day at the NC General Assembly on May 22nd from 8:30 am to 3:00 pm.  The Autism Society of North Carolina is a long time member of The Coalition, a group of 40 statewide organizations advocating on behalf of individuals with developmental disabilities, mental health issues, and the disease of addiction.  Telling legislators our stories is our most powerful advocacy tool.  Join us in making the concerns and presence of the autism community known to each NC State Senator and Representative.

Registration will begin at 8:30 Am and continue throughout the day on the back portico of the Legislative Building, located at 16 W. Jones Street.  During the morning hours Coalition volunteers, including ASNC’s Director of Government Relations Jennifer Mahan will be providing brief training on making the most of your Legislative visits and current issues impacting people with disabilities. There will be opportunities to listen in on Legislative Committee meetings and Legislative session throughout the day and The Coalition will be handing out popcorn starting at 11AM, with the Rally starting at Noon. If you plan to addend, we encourage you to make an appointment with your Legislators for May 22 as soon as possible. You can reach your NC state Legislator by calling the General Assembly switchboard at 919-733-7928 and you can find out who represents you via the General Assembly website.

ASNC would love to know that you are attending to we can assist you with talking points related to autism spectrum disorder and any questions you might have. Though registration is not required, please contact Jennifer Mahan at ASNC at jmahan@autismsociety-nc.org or call 919-865-5068 to sign up for our special ASNC Coalition Rally emailing list or for additional information.

[For those attending, a map of the Legislative Buildings and local parking can be found here.  Please note that there is a new parking lot located at Edenton and  McDowell Streets, near the old Education building and attached to the "green" building with the giant globe. Parking in downtown lots is NOT free. The Legislative buildings have several snack bars and a cafeteria and nearby Fayetteville street has a number of restaurants. ]

1915 b/c Waivers and Autism: What Does Managed Care Mean to Me or my Child?

The Autism Society of North Carolina is working on updating its 1915 b/c managed care waiver information on our website. Below is an article from The Spectrum ASNC’s newsletter about managed care waivers in North Carolina. Please feel free to post your questions and comments below.

Over the next two years, managed care waivers, also called 1915 (b)/(c) combination waivers, will fundamentally change the way all services for intellectual and developmental disabilities, mental health, and addictive disease/substance abuse (I/DD, MH, SA) are managed and delivered in North Carolina. If you get any state or federally funded services for Autism Spectrum Disorders, including those funded under CAP-MR/DD, Medicaid, state funds (IPRS dollars), and other funding, this will impact you.

Managed care waivers are a BIG change. Under managed care, the Local Management Entity (or LME or sometimes still called the Area Program or Mental Health Center) will get a per-member per-month fee to serve people with I/DD, MH and SA needs in their coverage area. Right now, NC has a fee for service system: the person gets the service and the provider bills the LME or Medicaid for those service hours.

LMEs will manage all public resources to serve MH/DD/SA including Medicaid, Health Choice, state funds/IPRS, federal block grants, and others. This has the potential to impact all publicly funded supports, services, and beds in their region, including state facilities like MR Centers and hospitals, Intermediate Care Facilities for people with I/DD (ICFMR), Community Alternatives Programs for I/DD (CAP MR/DD) services, residential programs, crisis services, developmental therapies, respite, etc. It includes people who are now served, who are on waiting lists, or who could be served in the future.

Managed care waivers save money by promoting “wellness” to avoid future costs and expensive care like hospitals. This is based on a medical model of care that has been shown to work well for people with mental illness and addictive disease. It may work less well for people on the autism spectrum and with other developmental disabilities who do not “recover,” who have lifelong conditions and need habilitative services that build and maintain skills for maximum independence. ASNC hopes it means that people get what they need to live their lives, and savings are focused on providing consistent services and supports, early intervention, and eliminating waiting lists.

It’s moving FAST. Two bills passed the legislature this past session that expand managed care from one region, Piedmont Behavioral Health (PBH), to every LME across the entire state in two years. House Bill 916 expands waivers statewide and Senate Bill 316 allows PBH to expand their waiver to more counties. [Note: Western Highlands LME intends to start the new waiver January 1 of 2012 and Eastern Carolina Behavioral Health LME plans to start April 1 of 2012. News and updates on 1915 b/c waivers from the state Division of MHDDSAS can be found here.]

H 916 does some good. The “aggregate funding” in the bill allows the LME under the waiver to take unused funds and use them to serve more people and/or provide more services and supports to people being served. There is continuity of care language that shows concern for making sure people who are getting services continue to get what they need, though the bill makes no guarantees. There is intent to use 15% of savings in future years to serve more people with I/DD, though the current General Assembly cannot legally obligate a future General Assembly to do so. There is a request to study the feasibility of an “i” option under Medicaid to provide supports to people with I/DD who do not qualify for an ICFMR level of care, but it stops short of committing to make it happen. ASNC will continue to advocate to make these options reality.

H 916 eliminates Targeted Case Management for people with I/DD. House Bill 916 models all future waivers on PBH, which has the LME managing service funds/utilization management (i.e. cost controls), eligibility, assessment, development of person centered plans, and care coordination. H 916 allows an LME waiver site to contract with an outside agency for “treatment plan development” and for the “community guide” service which ASNC believes will allow for some independent development of person centered plans and offers assistance to consumers and families. Care Coordination and Community Guide which is offered under the waiver is different than Targeted Case Management. In addition, the LME controls which providers it contracts with, and for what services, in its closed network.

H 916 does not fix guardianship problems under the waiver. Due to a court decision that says that the waiver LME cannot be an individual’s guardian, its unclear if the waiver LME can contract with an outside organization to provide guardianship services. Unless this is fixed, already over-burdened local Departments of Social Services would need to assume corporate guardianship of individuals. Disability advocates are pushing for a fix to this situation. (This does not affect people who have a friend or relative who is assigned guardianship.)

ASNC urges you to pay close attention to your local communities’ waiver plan development. Every LME has customer relations staff and should be soliciting input from the public as they make these changes. Many things about the impact of waivers are unknown. The Autism Society of North Carolina will continue to provide you with information on the new waivers as we learn more, will work at the state and local level to monitor implementation, and will recommend solutions to any problems that arise.

Please contact Jennifer Mahan, Director of Government Relations, with questions or concerns. She can be reached at 919-865-5068, 1-800-442-2762, ext. 1116 or jmahan@autismsociety-nc.org.

NC General Assembly Legislative Session Wrap-up

This article was published in The Autism Society of North Carolina’s summer 2011 issue of The Spectrum. Current and past issues of The Spectrum can be found under Publications on our website.

Families, self-advocates and ASNC faced difficult challenges in advocating for better services and supports for people on the autism spectrum as we headed into the long North Carolina General Assembly legislative session in January: ongoing tough economic times with a 2.2 billion dollar state budget deficit, new legislators unfamiliar with our needs, pressure from interest groups opposed to policy changes, and a determination across state government to use managed care for services to those with developmental disabilities.  ASNC pushed policymakers to think about the effects their decisions would have today and in the future. While we did not achieve all we set out to do, we were able to have some significant impacts.

 

Budget: At the beginning of the year, policymakers were expecting to make large cuts to all programs, including those that serve developmental disabilities. By the end, suggested cuts had been significantly reduced.  Most cuts to Medicaid we hope will come from efficiencies, connecting people to primary care services and better management tools. Cuts to state service funds were reduced to a $20 million onetime cut from a recurring $30 million cut.  Cuts to non-profit programs went from $ 10 million down to $ 5 million. Still, there will be significant impact; service providers have taken rate cuts for the last three years, despite needing to meet increasing quality standards and rising costs. Any reductions in a system that already struggles with waiting lists will likely come at the cost of people losing access to needed services and supports.

 

Other programs impacting children took deep cuts: Schools were cut by 408 million; early childhood education and development were cut by more than $55 million. Additionally, evidence backed programs like Smart Start will no longer be able to promote health screenings that help with early identification of children at risk for development problems.   ASNC pushed for legislators to take a balanced approach and keep current revenue streams in place to support these needed programs. Despite public support, legislators allowed the penny sales tax to sunset on June 30th.

 

Managed Care Waivers:  ASNC has made it a priority to advocate for I/DD system management options other than 1915 b/c managed care waivers for people with Autism Spectrum Disorder. Of greatest concern under managed care is the elimination of independent case management which creates a conflict of interest in managing the use of services (i.e. the cost of care) and determining an individual’s needs and plan of care. As the session progressed, it became clear that policymakers were determined to push managed care across the entire system.  ASNC pushed for additional consumer protections and for the voice of families, self advocates and local communities to be heard in the process.  Please see page 16 for expanded information about the new managed care waivers in North Carolina.

 

Autism Insurance Coverage:  Autism insurance bill sponsors introduced very good bills this year, Senate Bill 115 and House Bill 826, Coverage for Treatment of Autism Disorders. This bill ensure that North Carolina health plans cover services for ASD, so it’s disappointing that autism insurance legislation has not moved forward in the NC General Assembly this session. We all know it’s the right thing to do, so that those with autism get the services they need to be healthy and successful. We also know that it will save money in the long run by promoting independence.

Unfortunately, to get it passed, we need to convince NC General Assembly lawmakers to raise insurance standards in both private and public health plans, which is estimated to increase costs less than 1%. At this time, many lawmakers are against taking actions which would result in higher costs to business or state health plans. This is not the only reason that autism insurance bills have not passed, but it is a huge factor. Other factors include a lack of understanding about Autism Spectrum Disorder and its treatments, as well as opposition from powerful interests like the insurance industry and business associations.

 

The bill is still alive and will carry over to the short Legislative session in May-June of 2012. Between now and then, families, self-advocates, autism professionals, and other advocacy organizations must meet with their NC state General Assembly Legislators, especially those on the House Health and Human Services Committee, the House Insurance Committee, and the Senate Insurance Committee, to urge those lawmakers to pass the bill. 

 

Tax Credits and Corporal Punishment: Autism advocates had two solid victories this past session: House Bill 344, Tax Credits for Children with Disabilities, and Senate Bill 498, Modify Law Re: Corporal Punishment.  House Bill 344 Tax Credits for Children with Disabilities gives a $6,000 tax credit to families whose child with a disability moves from a public school to attend a private school or home school. To qualify for the credit, children must have been in a public school the previous two semesters, have an IEP, and be receiving special education or related services on a daily basis. The legislation also establishes a special needs trust fund to be administered by the NC Department of Education to supplement funding for special education services in the public schools. Part of the savings generated by the use of the tax credit will go to the trust.

 

Senate Bill 498, Modify Law Re: Corporal Punishment, requires schools to send a form at the beginning of the school year allowing parents to opt-out of corporal punishment for their children.  Many families are surprised to learn that 39 counties in North Carolina still allow physical punishment and that 17 are actively using it (Numbers are correct as of this printing. Counties are moving to ban the practice and this number may drop as we get closer to the school year start.) ASNC continues to promote positive behavioral supports and an end of the use of physical punishment for all children in schools. Previously, corporal punishment had been banned for students with disabilities; however, we know from parents that students with as yet unidentified disabilities continue to be subject to corporal punishment.

 

Your Advocacy: One of the best outcomes of this legislative session is that we heard that Legislators heard from you.  On managed care, on the budget, on education, on insurance – they got your calls, letters and emails.  Having real life examples of how Autism Spectrum Disorder is impacting you and your family does make a difference in public policy. ASNC needs that advocacy to continue to build so that every Legislator hears from families, self-advocates, and others in their districts.

 

Victories on autism insurance, funding for services, ending waiting lists, and creating lifetime supports will be won with your action. Policymakers were moved by your stories about struggling to find the right education options to ensure your child’s success. That same action is needed in the coming year to pass better insurance standards. ASNC challenges you not only to get involved, but to ask others who know you to join in this effort. Sign up for our e-updates, write letters, and pass them along to your neighbors with the request that they do the same.  

 Please contact Jennifer Mahan, Director of Government Relations, with questions or concerns. She can be reached at 919-865-5068, 1-800-442-2762, ext. 1116 or jmahan@autismsociety-nc.org. You can also leave your questions or comments in the comment section below.