April 13, 2022
The Joint Legislative Oversight Committee on Health and Human Services and the Joint Legislative Oversight Committee on Medicaid and NC Health Choice convened on Tuesday to discuss healthcare issues related to COVID-19, foster care and adoption, opioid settlement funds, Medicaid transformation, and more.
The Joint Legislative Oversight Committee on Health and Human Services met in the morning and received an update from NCDHHS on COVID-19. The state is now tracking new metrics as we move into a recovery phase of the pandemic, including wastewater surveillance data, COVID-like illness, CDC community level, hospital admissions, boosters, case trends and prevalence of variants. Wastewater surveillance and ER visits for COVID-like illness are used as early signs of community spread and illness, while reported COVID-19 cases and hospital admissions are used to indicate the strain of COVID-19 on the health care system. Monitoring vaccine data gives insight into the level of immunity within the state. 51% of North Carolinians are boosted, with 76% of adults vaccinated with at least one dose and 38% of children and teens vaccinated with at least one dose. Early detection of new variants and the weekly CDC community level map also helps the state inform response and prepare for future surges.
NCDHHS also highlighted the State of Emergency Flexibilities in place that are necessary for the state to respond to the ongoing pandemic. The current State of Emergency declaration allows for health care facilities and EMS agencies to have the flexibility to increase staff and other resources to manage surges. The State Health Director is also able to issue standing orders for testing and treatment, which particularly impacts the ability to continue COVID testing in schools and smaller local health departments. The Department continues to focus on recovering stronger through promoting behavioral health and resilience, child and family well-being, and building a strong and inclusive workforce.
The committee also received an overview of the state’s foster care and adoption system. In SFY2020-21, 15,239 children spent at least
one day in foster care in NC. Of the children who entered foster care, 83% were due to neglect, and more than 40% of children in foster care are 5 years old or younger. In order to have positive outcomes in Child Protective Services (CPS), statewide availability of wraparound services for kinship caregivers is critical to keeping children with their families, as well as statewide availability of quality behavioral health services for families and children in foster care. The Department said its coordinated approach is an important first step in reaching across service areas to provide for children and families’ overall well-being.
The committee also received an update from NCDHHS on the new Children and Families Specialty Plan. Children in foster care have specific challenges and needs and a wide range of stakeholders played an important role in shaping the CFSP design. The new plan will have a single accountable entity serving youth, children and families all over the state. The plan will focus on keeping families together, with access to continuous services, treatment plans and providers when children experience a change in placement. NCDHHS will need to obtain legislative authority during the short session to move forward with the plan. Keith Henry, COO of Baptist Children’s Home, also provided an update on congregate care settings for children in need, and two foster parents gave their perspective on challenges within the foster care system in North Carolina.
The NC Department of Justice updated the committee on the opioid setttlements that the state will receive and how the state can allocate the funds. A Memorandum of Agreement (MOA) between the State and local government directs how opioid settlement funds are distributed in our state. To maximize funds flowing to North Carolina communities on the front lines of the opioid epidemic, the MOA allocates 15 percent of settlement funds to the State and sends the remaining 85 percent to NC’s 100 counties and 17 municipalities. The agreement also ensures transparency about how local governments will use the funds. Counties and municipalities that receive settlement funds will need to open a special revenue fund that will be subject to audit. They will also complete annual financial and impact reports that will be available to the public on this website. NCDHHS will provide training and technical assistance to counties, and is partnering with the NC Association of County Commissioners and the Attorney General’s office.
The Joint Legislative Oversight Committee on Medicaid and NC Health Choice convened later in the afternoon. Dave Richard, Deputy Secretary for Medicaid at NCDHHS, provided opening remarks about the state’s Medicaid program. The federal government’s public health emergency (PHE) currently ends mid-April, but is expected to be extended through mid-July. NCDHHS will have to begin terminating cases of those who are no longer eligible for Medicaid once the PHE ends. CMS plans to provide states a 60 day notice prior to the PHE ending to begin unwinding activities, but the process will be complex and will require additional workload for counties along with engagement with providers, stakeholders and health plans. During the short session, NCDHHS will request legislation related to several Medicaid issues, including legislation to authorize the Medicaid program’s new Tailored Plan for behavioral health/IDD beneficiaries as well as the Children and Family Specialty Plan.
The Department also provided an update on Medicaid transformation and related Medicaid programs. North Carolina is the 1st in the nation to have a social determinants of health program designed to improve the health of Medicaid beneficiaries while reducing costs through the Healthy Opportunities Pilot. Healthy Opportunities was launched on March 15, 2022 for qualifying Medicaid members in 33 Standard Plan managed care counties. Services in the program include fruit and vegetable prescriptions and healthy food boxes, medically-tailored meal delivery, food and nutrition access case management, and group nutrtion classes. Housing and Transportation services will launch on May 1, 2022, with Toxic Stress services to begin on June 15, 2022.
NCDHHS also provided an update on NC Integrated Care for Kids (InCK), which launched in January 2022 for children who are insured by Medicaid of CHIP in Alamance, Orange, Durham, Granville and Vance counties. NC InCK is a CMS pilot grant with the goal of improving quality of care for children through prevention, early identification, treatment of behavioral and physical health needs. Building on Medicaid’s whole-person Advanced Medical Home care management model and practice-based incentive programs, InCK brings in additional data from schools and juvenille justice to better identify children who could benefit from additional care management supports. Committee members also received an update on the extended Medicaid coverage for postpartum women that was included in the state budget last year. Coverage became effective on April 1, 2022 and Medicaid for Pregnant Women (MPW) is now a full-benefit Medicaid program during pregnancy and postparum.
The prepaid health plans provided another update on Medicaid transformation, with representatives from United Healthcare Community Plan, AmeriHealth Caritas NC, Healthy Blue NC, WellCare of NC, and Carolina Complete Health. The panelists highlighted Medicaid transformation milestones from 2015-2020, and discussed how NC implemented its managed care model and new features of the program. PHPs have held Provider Administrative Simplification Workgroups to tackle challenges with transformation, and are collaborating on future intiatives to simplify and provide clarity for providers.
NCDHHS presented on NC Medicaid and Health Choice enrollment and finances. Medicaid enrollment has had a 26% increase since March 2022. The convergence of managed care and pandemic uncertainties, along with actual enrollment in the program exceeding projections, has caused increased budget pressures for Medicaid. Through February, NC Medicaid has expended a higher percentage of the total budget than at the same time last year. The Department previously believed they would run over budget this year, but the trends are moving in the right direction and the expected overrun will be within the predicted amounts. NCDHHS is working on next year’s rebase numbers, but there is uncertainty regarding the end date of the current PHE, new high-cost pharmaceuticals to cover, and the implementation of Tailored Plans. The Department also continued to push for Medicaid expansion as a solution to these issues and to draw down additional federal funds.