Issue: # 4 April 7, 2011

ARC Policy Blog

State presents disappointing plan:
Entire MHDDSA System to be Under Managed Care!!

On Tuesday 4/5/11, Secretary of Health and Human Services Lanier Cansler presented his plan to drastically restructure the MHDDSA system. The plan will place all of North Carolina's 100 counties in a 1915bc Managed Care Waiver by July 2013.  This model provides little protection for individuals with developmental disabilities. Whatever local connection LMEs possessed with their local DD community will be lost as they expand into large, regional entities.

 

The 1915bc Managed Care Waiver is based on a medical/ recovery model of services. People with DD do not "recover".  They gain and maintain skills through habilitative supports. The Arc continues to advocate for Intellectual/Developmental Disability services to be excluded from this wholly inappropriate process.

 

There is still time protect services for people with IDD.  Here are a few of the Managed Care plan issues you need to be concerned about:
  • People with mental illness are given "entitlement" services, while people with DD are not. Under the 1915bc Managed Care Waiver, there are some services to which people with mental illness and substance abuse are entitled.  Not so for people with IDD.  Use of the 1915i option could help provide vital services to a targeted group with IDD.  The state needs to investigate this option.
  • Independent Case Management will be eliminated. This function will go to the Managed Care LMEs, the same folks that determine eligibility, funding, available providers, and develop the person-centered plan- all in the same organization.  Independent case management has been a national best practice principle in the DD field for 20+ years,  AND case management has been the one service that people with DD could access when no other services were available.
  • DD funding could moved to other services. There will be no financial firewalls protecting funds from being shifted away from DD.
  • Budgets will be determined by an untested resource allocation tool developed by PBH. Consumers and families may lose the benefits of need based, individualized decision-making as this new resource allocation tool replaces individualized plan development.

 

If DD services are to be included in the 1915 waivers the following issues must be considered:

 

  • DD funds only used for DD until all people are served appropriately. Tighter financial restrictions for DD consumers for the purpose of creating "savings" to be used across all lines of service harms DD consumers.
  • State facilities and ICFs are managed statewide. Facilities operated under Certificates of Need must be operated according to state CON laws.  
  • Case Management remains a service independent from the LME and Service provider. The same agency can not be Case Management and service provider for the same person.
  • The 1915i Option must be inside any new waiver. 
  • No one on the new waiver may have services reduced more than 5% in any one year, regardless of resource allocation formulas.
  • People living in an ICF can not be forced to move from their setting without due process, and must retain the same rights to service if they leave. 
  • Regional Managed Care entities must be able to use aggregate funding with CAP/DD service models.
  • DD utilization review must not be driven by the medical model or financially focused "savings." 
  • DD advocates/providers /consumers and families must be a part of the development and review of any new RFAs issued for LMEs who are considering management of the waiver.
Stay Informed: Your Voice Will Be Needed
  The Arc of North Carolina is committed to keeping you informed of what is going on in the legislature because when it is time to act every voice matters and this year we are facing a crisis of monumental proportions. Thank you for being an advocate for people with disabilities.
The Arc of North Carolina appreciates your advocacy. Together we can make a difference and work to ensure that people with intellectual and developmental disabilities have the opportunity to lead full, rich lives in the communities of their choosing.
Please feel free to call us at 1-800-662-8706 or 919-782-4632
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