Advocacy Updates and News
Please click on each topic to access the information available
August 27, 2015
August 25, 2015
August 20, 2015
August 18, 2015
August 17, 2015
The House is expected to vote NOT to concure with H 372 Medicaid Transformation bill this week, which means it will go into conference.
August 11, 2015
The Senate just finished the debate on H372 Medicaid Transformation and it passed on 3rd reading by a vote of 34/10. The bill will be engrossed and sent back to the House for concurrence. Engross, for this purpose, means the process by which adopted amendments and other changes are incorporated into a bill as it makes its way through the Senate or House.
August 6, 2015
Below is a link to a summary of the Proposed Committee Substitute for H372 Medicaid Transformation/HIE/Primary Care/Funds. It was heard in the Senate Healthcare Committee this morning and received a favorable report. It has now been referred to the Senate Appropriations Committee to address the financing portion.
July 20, 2015
Articles of Interest
July 15, 2015
July 6, 2015
Articles of Interest
July 3, 2015
July 2, 2015
Legislation that creates "reasonable and prudent parent standards" for a foster parent was signed into law Thursday by Gov. Pat McCrory. Senate Bill 433, titled "Foster Care Family Act," passed 47-0 in the Senate on June 23 after passing the House 118-0 on June 16. The bill allows a foster parent, without previous approval of the county Department of Social Services, to give permission to the foster child to participate in extracurricular and social activities that include overnight stays of up to 72 hours without the presence of the foster parent. Other provisions include revising the juvenile code to deal with abuse, neglect and chemical dependency; being able to obtain optional liability insurance for foster parents; and making it easier for foster children, as well as those in the custody of the state Department of Health and Human Services, to obtain a driver's license and automobile insurance. The availability of optional liability insurance for foster parents became law Thursday. Also effective Thursday is a requirement that the Department of Health and Human Services submit a 1915(c) Medicaid waiver request to federal regulators to be able to serve children with serious emotional disturbance in home and community-based settings. DHHS is required to provide a status update on the waiver request to a joint legislative committee by Dec. 1. The rest of the legislation becomes law Oct. 1. Sen. Tamara Barringer, R-Wake, and a co-sponsor of the Senate bill, has said the measure aims to resolve the issue "of bringing a foster child to a family and then making them sit on the sideline of life as a child." There are "Fostering Success" bills in the House and Senate, both affecting the age limit for individuals in foster care and guardianship. House Bill 424 passed 115-0 on June 9. It has been placed in the Senate Health committee where it has not been acted on since June 10. Senate Bill 424 has been in the Appropriations and Base Budget committee since June 2. The financing elements necessary for both bills to make financial adjustments are in their respective state budget proposals. The bills differ in how much they would raise the age limit for fostercare services. The House bill would increase the age to 19, and the Senate bill would increase the age to 21. (Richard Craver, Winston-Salem Journal)
June 30, 2015
Continuing Resolution Bill that the House passed last night:
From the News & Observer: General Assembly lawmakers signaled a possible agreement late Monday on a way to keep state government funded as it lapses into a new fiscal year without a new budget. The House approved a funding bridge that essentially continues the current year's spending levels until August 14 -- ideally enough runway for the legislature to finalize and send the governor a new, two-year spending plan, which will not be ready by the new fiscal year starting Wednesday. Without a funding structure, the state couldn't legally fund programs, paychecks or schools, though budget officials may adopt a contingency plan to continue essential services. The Senate plans to take up this "continuing resolution" Tuesday morning. It's not a rare event. According to the legislator's Fiscal Research Division, continuing resolutions have given budget negotiators time extensions in six of the last 10 years. But Rep. Nelson Dollar, a Cary Republican and senior chairman of the House Appropriations Committee, noted it would be a 100 percent funding extension, where past continuing resolutions have funded government at 95 percent.
June 29, 2015
Below is a link to the DHHS portion of the House/Senate Comparison document on the Money Report of HB 97-Budget Bill as prepared by legislative staff. To date, we have not seen a comparison of the special provisions. Some of the House Appropriations Subcommittees will meet to go over the Senate's budget. HHD has not indicated on the legislative calendar whether they will convene on Tuesday.
June 18, 2015
Today in the House Appropriations Committee, by voice vote, the Committee approved its chamber's Medicaid Reform proposal.
The House proposal (House Bill 372) would transition the state's Medicaid and NC Health Choice programs from fee-for-service to full-risk capitated health plans operated solely by provider-led entities (PLEs). See Bill, Summary and Proposal below as well as a summary of the Committee's meeting.
Click on the link above to access the notes from the Senate HHS Appropriations Committee
Below are links to the Senate Budget documents and a rough review of the budget prepared by our Consortium Liaison, Sharnese Ransome. Additional information will be provided as it is made available.
- The Senate budget does not include recurring funds for the $4.8 million in State CPS non-recurring funds that will expire June 30, 2015. Our lobbyist is working on this issue and suggestions are being made regarding getting the funds from the TANF Block Grant. Hopefully, the Senate will take this suggestion and use the money elsewhere like the House did in their budget.
- The Senate budget extends the age of foster care to 21 and counties are held harmless from contributing fifty percent (50%) of the nonfederal share of the cost for an individual receiving benefits pursuant to G.S 108A-48(c). Supported by money report item #32 and #33 for adoption assistance.
- Child Welfare Case Management System, supported by money report item #8.
Special Provision reads as follows: CHILD WELFARE CASE MANAGEMENT SYSTEM
SECTION 12A. 14a.(a) Funds appropriated in this act to the Department of Health and Human Services, Division of Central Management and Support, in the amount of five million eight hundred three thousand dollars ($5,803,000) in nonrecurring funds and prior year earned revenue in the amount of two million seven hundred fifty-two thousand one hundred fifty-one dollars($2,752,151) for the 2015-2016 fiscal year and in the amount of thirteen million fifty-two thousand dollars ($13,052,000) in nonrecurring funds and prior year earned revenue in the amount of four million one hundred thousand eight hundred twenty-four dollars ($4,101,824) for the 2016-2017 fiscal year shall be used to purchase a child welfare case management system that has demonstrated its ability to provide child welfare case management services in another state within the United States. The Division shall purchase a system that can be integrated with North Carolina Families Accessing Services through Technology (NC FAST) and the work product of the Child Protective Services Pilot Project being conducted in accordance with Section 12C.11 of this act. The Division shall issue a request for proposals (RFP) in selecting a system for purchase. The Department shall not move forward with implementing the child welfare case management system in NC FAST. (Sec 12C.11 is the CHILD PROTECTIVE SERVICES PILOT PROJECT with Government Data Analytics Center (GDAC)).
SECTION 12A.14.(b) It is the intent of the General Assembly that beginning fiscal year 2016-2017, all Department of Health and Human Services' information technology assets, resources, and personnel transfer to the Department of Information Technology, as created in this act. To that end, the planning, development, and implementation of the child welfare case management system described in this section shall be coordinated with the Department of Information Technology.
SECTION 12A.14.(c) The Department shall report on the results of the RFP to the Joint Legislative Oversight Committee on Health and Human Services, the Joint Oversight Committee on Information Technology, and the Fiscal Research Division no later than October 1, 2016.
- Senate Block Grant Plans: varies some from the House. They do not fund Boys and Girls Clubs; there is an increase in TANF funds for child care subsidy; slight increase in SSBG County DSS; slight increase in SSBG for State In-Home Services, State Adult Day Care; and slight decrease in SSBG for Home and Community Care BG and decrease in SSBG for Guardianship. In CCDF there is a slight increase in child care services for year one and quality and availability initiatives.
- Adult Day Health/Respite Care provision not included in Senate budget.
- Medicaid Transformation and Reorganization, Section 12H.24, supported by money report item #37.
June 15, 2015 Article of Interest
It looks like House and Senate Republicans are nearing the same impasse they reached a year ago over the best way to overhaul how the state Medicaid program pays to treat its 1.8 million patients. As House leaders began running through committees last week their preferred Medicaid proposal - one very similar to what they voted for in 2014 - Senate budget-writers prepared this week to unveil a government spending plan expected to contain Medicaid reforms like those the Chamber's Republicans strongly backed last year. And like last year, hospital and physician groups and Gov. Pat McCrory's administration favor the House proposal, while insurance plans are aligned with the Senate. A lot is at stake, with more than $13 billion spent annually by the state and federal governments on the program serving mostly poor children, older adults and people with disabilities. But it appears chances may be improved to reach an agreement before lawmakers adjourn this summer. First, Senate Republicans have made an official caucus position to get a Medicaid overhaul law completed in 2015. "They do not want to leave Raleigh until we have Medicaid reform," said Sen. Tom Apodaca, R-Henderson, chairman of the Senate Rules Committee. By preparing to incorporate their Medicaid overhaul within their budget proposal, senators may force House counterparts to negotiate the Medicaid payment overhaul within the year's most important bill. "Hopefully, we can get moving on it fairly quickly," Apodaca said.
Rep. Nelson Dollar, R-Wake, a primary sponsor of the House Medicaid proposal, remains hopeful that a deal could be reached this year despite the differences. Informal talks have occurred in recent months. "I believe that we will move forward with Medicaid reform," Dollar said. Both chambers agree on moving away from the traditional fee-for-service model, in which Medicaid pays for each procedure or office visit. Instead, medical organizations would receive flat monthly payments for each Medicaid patient served. These organizations would eat cost overruns but could keep what's left over if costs are less than the amount received. But the House plan essentially limits doctors, hospitals and other medical providers to forming these organizations. Senate Republicans insist that managed-care organizations and insurance companies be allowed to participate, too. Neither proposal tries to expand Medicaid enrollment through the 2010 federal health care law. The House wants more aggressive timeline, said Sen. Ralph Hise, R-Mitchell, a budget-writer on Medicaid matters. Senate Republicans say it makes sense to bring in insurance companies that manage Medicaid expenses in other states, and they're not persuaded "provider-led" entities alone can create enough cost savings. "We think competition's important in any kind of Medicaid reform," said Sen. Harry Brown, R-Onslow, co-chairman of the Senate Appropriations Committee.
Retired hospital president Rep. Donny Lambeth, R-Forsyth, said there will be competition under the House plan, as networks bid to care for groups of at least 30,000 patients. Having medical providers lead the entities will emphasize quality service and patient health, he said. "We don't want an HMO between the doctor and the patient," Dollar said. Successful cost containment by Community Care of North Carolina reinforces the House position that physician-led networks can work. While Medicaid cost overruns were publicized in the past, House leaders say relatively flat claims growth show the Senate's more dramatic plan isn't needed. McCrory's veto power also could influence the final product. Senate Republicans may benefit most from the lack of unity among House Republicans on their proposal compared with a year ago, when it passed the chamber unanimously. The division could help senators gain leverage. Several Republicans on the House Health Committee debating the bill last week voted "no" or criticized the measure. Some were worried handing responsibilities only to provider networks could be devastating if they fail. "We are putting all of our eggs in one basket," said Rep. Justin Burr, R-Stanly, who was a primary sponsor of the 2014 House bill. "There's a place for managed care . . . there's room for everyone to come to the table." (Gary D. Robertson, The Associated Press, 6/14/15).
The Advocacy Committee did not meet on June 1, 2015 because of scheduling conflicts. We did meet on June 8.
Medicaid is driving the schedule relating to the NC Budget for the next biennium. The Senate and House are divided about the best path to achieve reform. You will find much discussion about the particulars in the media as well as in communications we will provide.
Our Consortium is solidly in favor of proposed legislation extending the period foster children may remain in care to age 21. Most of our children require our support beyond age 18. However, we are concerned that our Legilsators recognize the expanded staff time and associated costs. Additionally, we are concerned about the lack of placement resources for these young adults.
Additional information is being forwarded from our liaison and lobbyist and will include the Legislative Report and information about Medicaid reform.
In addition, the following bills have been forwarded to the Governor for his signature:
The following bill has been ratified:
NOTE: The most recent version of the Bill Tracker has been added to the Member's Only section of this website. Please return to the Home Page and log in as a member to view the document.
Please click on the link above to view the Legislative Update for this week.
The Advocacy Committee met via conference call on Monday, May 11th. We now have some tentative timelines for the budget process. Very little committee work took place this past week. Our Lobbyists indicate that the House will be focusing on completing its budget and will give little time to pending bills. The Senate will be able to spend time on pending bills while it waits for the House to complete its work on the budget.
We learned this morning that different advocacy groups are releasing information showing that County DSSs are not registering as many voters as in the past. A lawsuit has been threatened suggesting that the numbers indicate a purposeful lack of attention to voter registration to benefit the Republican party in the 2016 election. Your County DSS Director has the actual numbers for your county.
Please click on the link above to view the Legislative Update for this week.
Please click on the link above to view the Governor's Budget Bill with special provisions and block grant plans for 2015-16, pages 41-96.
Please click on the link above to view the Legislative Update for this week.
The Advocacy Committee met April 6, 2015, April 9, 2015 and April 20, 2015. Our Lobbyists and our liaison, Sharnese Ransome, have identified all Legislative actions that may affect families we serve and our staff who serve them. The Advocacy Committee has spent significant amounts of time identifying which are most pertinent to our County Departments of Social Services. A comprehensive list of pending Bills has been developed that provides a summary of each Bill, current status, and history. During these Advocacy Meetings, we have agreed on our position relative to each Bill: Support, Oppose, Neutral, or No Position. We are seeking more information on some of these Bills.
The most current Bill listing will be sent to you when completed. Additionally, we will post the listing on our website.
The cross-over deadline this year is April 30th. The Governor's Budget has been released and is currently being reviewed by our Lobbyist. The House is due to present their budget before the Senate this year. Early work has been dedicated to Health and Mental Health issues.
The Adovcacy Committee will meet again on Thursday April 23. Bill will be away and your Vice-President, Betsy Wells, has agreed to participate in that Committee Meeting representing the Association.
Please be reminded of the quarterly meeting in Burlington on May 15, 2015. In an earlier memo, Bill identified some of the Agenda items. He will send out the final Agenda in advance of the meeting.
March 23, 2015
Legislators are currently spending time in Committees heariing Special Reports, e.g., prenatal care, mental health issues, etc. They have not strated addressing the budget. Legislative Staff have invited HHS Staff over to discuss the Governor's budget. The House budget was expected by March 15. It now looks like they will wait until the revenue picture is clearer.
Senate Bill 14, that provides for the Medicaid Audit by our State Auditor, has been an issue we are trying to address. The Bill's sponsors are considering changes in the proposed legislation that could be helpful.
Most of the time in this morning's Advocacy Committee Meeting was spent discussing a Bill that calls for changes in the Healthcare Power of Attorney Law. Some are concerned that the change would weaken the process and could result in increased adult abuse and/or exploitation. More information and perspectives are being sought after in an attempt to provide a suggested compromise.
Sharnese Ransome, our liaison to the Lobbyists, indicates that she has already witnessed benefits resulting from our new Lobbyists. She reports that our new Lobbyists are very responsive and are making the appropriate contacts to bring about a successful outcome to our Legislative Goals. She is in contact with our Lobbyists five or six days each week. She will have the necessary information at the end of the year to provide a full evaluation of our lobbying effort.
The Appropriations Committees are still reviewing the Governor's budget. We do not know when the House will release its proposed budget.
Sharnese Ransome, our Coordinator with our Lobbyist, reports that the relationship is going well with at least weekly discussions and ongoing reports. The reports that we are now receiving would not be available it it were not for our contract with our current lobbyists.
Questions continue to surround the audit that was referenced on March 10th (See Urgent Update below). There is much speculation concerning who is behind it, the motivation, and the use of the findings. Everyone continues to be concerned about the estimated $2 million losses each month resulting from delays in determining eligibility. The $2 million estimate is based upon experience and the assumption that 85% of the people we have not retermined eligibility for are eligibile. The 15% estimated not to be eligible explains the $2 million loss.
Click on the link above for the most recent Legislative Summary from our Lobbyist. Highlights include: Conversation with Rep. Burr and stakeholders regarding child care subsidy policy revisions; Planned meeting to discuss child care subsidy policy issues with Senator Barringer; and SB 14.
Click on the link above for a summary of the HHS portion of the Governor's 2015-17 biennium recommendation budget that was presented at the Joint HHS Appropriations Committee.
The Joint Full Appropriations Committee met this morning for an overview of the Governor's budget. Click on the link above for a summary of the meeting.
Included as an add-on to coal ash legislation is a call for an audit of Medicaid by the State Auditor. This is significant with important implications for county staff, county DSS Directors, County Boards of Social Services, County Managers and County Commissioners. Some Legislators feel that counties are not doing enough to get the resources required to do the work in Medicaid. Additionally, some believe that DHHS is not providing the oversight required. Some believe that the county's extension of Medicaid certifications for recipients is resulting in significant Medicaid costs. This is particularly sensitive since counties no longer participate in paying for the costs of Medicaid services.
The motivation is not clear. It may be related to the negative working relationship between the Secretary and the members of the General Assembly. The motivation may relate to the discussion of privatization of the Medicaid Program. Some members may want to revisit the cost shifting in the Medicaid Program with a return to county participation.
It is important that your DSS staff, the County DSS board, county manager, and county commissioners are aware of the likelihood for this audit and are well informed about the situation in each county. Were staff added to address the Medicaid challenge? Was County money that was freed up because of the new Federal 75% reimbursement rate invested in additional Medicaid staff or was it used to pay the County back for funds expended to address the NC FAST Food Stamp fiasco?
It looks like this issue is not going away. I do not think it is smart to oppose an examination of what County DSS's are doing. However, it is critical that we be able to use the findings of an audit to strengthen our services to families.
Please share this information with the County Boards in your district. Let me know if you have any thoughts.
Thank you for you all that you do for families in your county.
The link above provides a summary of Governor McCrory's 2015 Budget. You may click HERE to access the Budget itself.
The above link will provide a summary of today's Joint Appropriations Committee on HHS meeting. The topic of discussion was the integration of publically-funded substance abuse programs into the State's existing community-based mental health service delivery system managed by LME/MCO.
NCACBSS President Bill Scarlett represented the Association on the Advocacy Committee Meeting on March 2, 2015.
Most of last week's Legislative activity was canceled or rescheduled because of adverse weather conditions. A report from the DHHS and the Division of Medicaid concerning current spending and spending projections is expected this week. Remember that the House is in the lead this year in providing a budget for consideration. The Governor's budget was expected to be released on February 23. It has not been released and is now projected to be released in the middle of this week. Among the areas of interest will be the inclusion of funding for our Child Welfare services.
There appears to be some shared interest from Child Care Advocacy groups and our Consortium around making some changes in some provisions relative to the child daycare legislation passed last year. Specifically, the changes would address:
(1) Who is defined as a "relative care giver";
(2) Increasing eligibility of children ages 0 to 12 in families with incomes up to 200% of poverty (Currently 133%);
(3) The pro-ration formula that determines how providers are paid.
Also discussed was child daycare fraud. Current policy requires counties who identify fraud to reimburse the State immediately, before acquiring repayment from families who have committed the fraud. This policy discourages counties from identifying fraud.
Below is a link to an article provided by our lobbyist regarding Medicaid Expansion. It's informative and Bill recommends it to all members. There is really only a minimal amount to report until the legislators get going and committees begin to meet. We can expect to receive detailed reports at that time. Additionally, we can expect to have our lobbyists identify the critical legislators affecting our issues so that we can attempt to inform and influence those legislators.
Later this week, or next, we will be provided a "one pager" document summarizing our legislative agenda. That will be posted upon receipt.
In light of a very slow week in Raleigh due to the winter storm canceling most all committee work, a HHS Budget and Policy Implementation Status Report is being provided in place of the legislative update.