A statewide foster care plan favored by state health regulators has reached the Senate floor for the second time after a series of clarifications were approved by the Senate Rules and Operations Committee.
The North Carolina Department of Health and Human Services has proposed to manage foster care services through the overhaul House Bill 144with plans to debut by December 1, 2023.
HB144 has been amended for what the sponsors of the bill believe will resolve confusion as to its intent.
However, opponents of the bill still don’t like that counties — like Forsyth — can’t opt out of the plan if it becomes law.
HB144, titled Medicaid Children and Families Specialty Plan, reached the Senate floor on June 8, only to be referred to health care to respond to an amendment submitted by Sen. Joyce Krawiec, R-Forsyth.
Krawiec expects a Senate vote on HB144 this week. Dave Richard, the state’s assistant secretary for Medicaid, said the plan is expected to cover about 31,000 young people statewide through providers already participating in the state’s Medicaid program.
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About 218 Forsyth youths have received foster care services from its managed care organization, Partners Health Management, since Forsyth joined Nov. 1.
Krawiec said the amendment removes a limitation on prepaid health plans that “will open offerings to any qualified provider.” Each of the state’s six behavioral healthcare organizations is eligible to bid, she said.
The amendment also removes a limitation allowing entities with common ownership to submit more than one bid.
Perhaps the most notable clarification is that a child cannot be removed from the plan unless DHHS requests it and the federal Centers for Medicare and Medicaid Services approve it, because “they do it in the best interest of the child”.
DHHS said in a statement that “we hope all parties can work together to resolve differences so that we can move forward with this plan to meet the specific needs of children in foster care.”
Proposals for the statewide plan would be sought from prepaid health plans operated by health insurers that already have contracts with DHHS.
DHHS would be responsible for determining what services would be offered in the plan and which Medicaid and NC Health Choice beneficiaries are eligible to enroll.
The bill specifies that these services must include: intensive home care services; multi-systemic therapy; residential treatment; and services in private residential treatment facilities.
The goal is to “support family preservation, advance family unification, support child permanency goals, and support the health of former adoptive youth.”
Key elements of HB144 would require the state’s six MCOs to “stop operating Medicaid services” for most children in foster care.
The bill would also require area authorities to operate the plan under a contract with DHHS.
The primary purpose of the state’s six behavioral health MCOs is to oversee mental health, substance use disorder, intellectual/developmental disability, and traumatic brain injury service providers.
They also play a role in ensuring that children in foster care receive proper health and medical care, as well as other services.
Krawiec told Rules and Operations members that “at the moment we have a very fragmented system.”
“These children go from one region to another and their insurance does not accompany them.
“With a statewide plan, they’ll have one (insurance) card, just like you and me, and they’ll be covered wherever they go in North Carolina.”
HB144 and the plan is opposed by the state’s six behavioral health MCOs and at least 30 counties, including Forsyth, who all say they want to keep foster care services as close to the premises as possible.
The primary purpose of Behavioral Health CMOs is to oversee mental health, substance use disorders, intellectual/developmental disabilities and traumatic brain injury service providers. They also play a role in ensuring that children in foster care receive proper health and medical care, as well as other services.
Among the partner counties are Davie, Forsyth, Surry and Yadkin as members. Forsyth is by far the largest member in terms of population.
“CFSP’s current proposal would move many young people into the care of the Department of Social Services outside the management of Partners, creating another change too soon in an already complex system,” wrote board chairman David Plyler. of Forsyth County Commissioners.
Forsyth Commissioners and DSS staff expressed satisfaction with Partners’ management of the foster care service.
“CFSP’s proposed design of a single, statewide plan will jeopardize, rather than sustain, the progress we are making and the purposeful infrastructure we are building with our partners,” Plyler said.
Vaya Health counties include Alamance, Alleghany, Ashe, Stokes, Watauga, and Wilkes. Among the Sandhills counties are Davidson, Guilford, Randolph and Rockingham.
The six MCOs and counties say they were told in April by Richard that counties can opt out of the plan contained in HB144.
“It’s a little confusing,” Krawiec said last week when discussing opt-out language.
“I believe there was a misunderstanding about what Dave said, but we had a long discussion. Counties could never opt out as a whole, but that can only be done on an individual basis.”
Partners said “establishing a new, redundant, statewide plan would cost North Carolina taxpayers millions of unnecessary dollars, and it would significantly limit choice and control for all counties in Carolina.” of the North who care for many of our most vulnerable children”.
On May 1, the six MCOs unveiled the North Carolina Child and Family Enhancement Initiative, which represents their first collective step toward providing an alternative to the proposed foster care service plan. statewide.
MCOs said a primary goal of the initiative was to demonstrate their ability to “implement a statewide model to ensure seamless access to quality care for these children and their families, regardless of where they live in North Carolina.”
On Tuesday, MCOs provided new details about the initiative, including:
* Create a statewide network of providers to ensure access to residential treatment and other services;
* Ensure a standardized and transparent process for children moving from one MCO region to another or changing custody to a new Department of Social Services;
* Establish rapid access to care by reducing authorization barriers for residential treatment; and
* Increase crisis care capacity across the state.
MCOs expect “the immediate improvements resulting from this partnership to be fully functional” before the December 1 launch of NC’s Behavioral Health and Intellectual/Developmental Disabilities Tailored Plans.
Kevin Leonard, executive director of the NC Association of County Commissioners, said in a statement Tuesday that “we applaud the rapid collaboration of MCOs across the state to develop a coordinated statewide strategy to ensure children and families who are in the foster care system have a quality care experience.
“The immediate and significant efforts of the NC Child and Family Enhancement Initiative support NCACC’s request that DHHS suspend implementation of a statewide plan, which would leave time to measure the results of the MCO.
“It would also give all stakeholders the opportunity to have a dialogue that will help develop a long-term, lasting solution to better serve children in foster care programs across the state.”