March 13, 2024
The Jt. Legislative Oversight Committee on Health and Human Services and Medicaid met this week to receive updates from the NC Department of Health and Human Services related to the NC Vital Records System, Office of the Chief Medical Examiner, Medicaid enrollment and finances, and the direct care workforce.
NCDHHS Secretary Kody Kinsley provided opening remarks for both meetings and shared that the Department was continuing to focus on improving work for individuals with disabilities and released an update to the Olmstead Plan several weeks ago, which is designed to push the system of care to more community-based models of care for people with intellectual and developmental disabilities and traumatic brain injuries. The Department is also launching a new initiative called Inclusion Connects to offers individuals more linkages to community-based services, and is focused on increasing the number of Innovations Waiver Slots.
Secretary Kinsley discussed a new emergency placement fund from NCDHHS which provides $8 million to assist county departments of social services to help improve placements for children in DSS custody who have complex behavioral health needs. Secretary Kinsley also shared an update on the progress of Medicaid expansion. Over 389,000 people have enrolled since expansion went live on December 1, with nearly half a million prescriptions filled and millions of dollars in dental claims.
Mark Benton, Chief Deputy Secretary for Health at NCDHHS, provided an update on the Office of Vital Records (OVR), which is responsible for collecting, preserving and administering the NC system of vital events (birth, death, fetal death, marriage, and divorce). Benton shared information on the digitization of vital records, the NC Database Application for Vital Events (NC DAVE) System, and issues with backlogs and processing times for birth and death certificate amendments. Benton also shared that the Office of the Chief Medical Examiner is implementing newly enacted requirements for toxicology screenings in all child deaths and autopsies for suspected “Death by Distribution” cases. He discussed the strategic plan for improving the medical examiner system and capacity-building within OCME.
The JLOC on Medicaid received a Medicaid financial update from Adam Levinson, Chief Financial Officer for NC Medicaid. Enrollment for the non-expansion population of the Medicaid program has seen a slight increase due to an increase in children enrolled in the program. NC Medicaid has spent approximately 53% of its appropriations budget for the year and the Department is predicting to end the fiscal year within 1% of its budget. Moving forward there will be additional state funding needs as a result of the federal match rate decrease, known as the FMAP. The FMAP decrease (.6591 to .6506) is due to North Carolina becoming a wealthier state, which changes the federal government’s match for the program. Additional state funding will also be needed to modernize rates for Medicaid providers, many of which haven’t been updated since 2012-2015.
Jay Ludlum, Deputy Secretary for NC Medicaid, shared an update on Medicaid transformation and Medicaid expansion. Tailored plans for individuals with behavioral health needs and intellectual/developmental disabilities (I/DDs) are expected to launch on July 1, 2024. The department is verifying the LME/MCO’s readiness to launch by reviewing contract deliverables, network adequacy, functionality, and system readiness. The department is also planning to launch a statewide NC Medicaid Managed Care plan to support Medicaid-enrolled children, youth, and families served by the child welfare system statewide and is in the process of reviewing RFPs to manage the plan.
Ludlum provided an update on the Electronic Visit Verification (EVV) program, which all states must use for Medicaid-funded services. EVV is a Fraud, Waste and Abuse program that tracks and monitors timely service delivery to verify that people who should receive services are receiving them. Due to outstanding issues in Home Health EVV for managed care when the program hard launched, NC Medicaid directed PHPs to roll back to a soft launch, pay outstanding and unpaid EVV claims back to October 2023, and set a new launch date in Summer 2024. Ludlum also shared claims processing data for the PHPs, citing that 97.6% of Medical claims are paid within 30 days and 99.6% of Pharmacy claims are paid within 14 days.
Through Medicaid expansion, around 1,000 individuals are enrolling in the program each day. The state is also allocating funds from the $1.8B signing bonus from the federal government for enacting Medicaid expansion. The Department is providing support for counties with the launch of Medicaid expansion by supporting flexibilities, policy changes, and automation of some services. NC Medicaid provider enrollment and participation
continues to increase and primary care enrollment is rebounding.
The last presentation was an update on the direct care workforce in NC from Kellie Crosbie, Director, Division of Mental Health/Developmental Disabilities and Substance Use Services. Direct Support Professionals (DSPs) provide care and support to people with intellectual and/or developmental disabilities so that they can participate fully and meaningfully in their communities. DSPs have a turnover rate of ~33% and half leave their jobs within 36 months. NC would need about 20,000 DSPs to meet the needs of people with IDD on the Innovations waitlist. Although the state budget included support for the DSP workforce, challenges remain. DHHS is developing a comprehensive strategy that includes career pathway support, living wage increases, and incentives for employees.
The committees plan to convene again on Tuesday, April 2nd.