In this public policy update:
- Medicaid Tailored Plans move forward;
- B(3) Services transition to 1915i;
- Samantha R lawsuit consent order;
- State releases new Olmstead Plan for 2024-2026.
Medicaid Tailored Plans will move forward as the next phase of Medicaid Transformation goes into effect. North Carolina has been changing its Medicaid system for several years. The goal is to have Medicaid physical health care, behavioral health care, developmental supports, and pharmacy benefits managed together and introduce programs that address social issues to keep people healthier. “Transformation” integrates physical, behavioral, and intellectual and/or developmental disability (I/DD) services into two types of Medicaid health care plans: Standard plans and Tailored plans (TP).
Tailored plans offer more specialized services to people with Intellectual and /Developmental Disability (I/DD) who have Medicaid, as well as those with significant mental health or substance use disorder issues. People who have an Innovations Waiver or a Traumatic Brain Injury waiver will need to be in a Tailored Plan to get home and community-based waiver services. Those on the Registry of Unmet Needs, aka the waitlist, who have Medicaid, can qualify for new services to help in the home and community, called 1915i offered under the Tailored Plans.
Tailored plans have been delayed several times but go into effect on July 1, 2024. Medicaid participants eligible for a Tailored plan, mainly those who already get services through the LME/MCOs, began getting notices of the change to Tailored Plans the week of April 15. Tailored Plan members need to select a Primary Care Provider before May 15, and those who do not will be assigned to one. It is also important to ensure specialty medical providers are in your Tailored Plan Network. The Autism Society of North Carolina Medicaid Transformation webpage has more info about this public policy update and what Medicaid participants need to do.
B(3) Services transition to 1915i as part of Medicaid Transformation and Tailored Plan launch. When Medicaid Tailored Plans launch on July 1, 2024, the current B(3) services like respite offered by the LME MCOs will change to 1915i services. As ASNC has written about previously, 1915i services are an entitlement for people with Medicaid. 1915i has similar services to those offered under B(3) but with additional services and service hours not available previously. Read more about 1915i services and how to access them in our public policy update blog here.
NC Department of Health and Human Services (NCDHHS) and Disability Rights North Carolina (DRNC) have reached an agreement in the Samantha R et al. vs. NCDHHS and the State of North Carolina lawsuit. In our last update on this litigation, NCDHHS had appealed the judge’s order. This new “consent order” means that DRNC and NCDHHS have come to agreement on how to move forward with efforts to improve access to community-based services, to prevent people with I/DD, including those on the autism spectrum, from being unnecessarily confined to institutional settings, and to make sure that those who currently reside in those settings are aware of their options. Because DHHS controls how funding is used, but not the overall amount of funding or waiver slots, this new order does not require the state to end the Innovations waiting list or end admissions to facilities, but it does signal NCDHHS’s commitment to make sure people with I/DD have the resources they need to live healthy, independent lives in communities of their choosing. With the appeal resolved, DRNC and NCDHHS have said that they will spend the next two years making sure the system is pointed in the right direction. You can read the joint statement from DRNC and NC DHHS here.
State releases new Olmstead Plan for 2024-2026: NCDHHS has released their new two-year Olmstead Plan for North Carolina, which outlines the way that North Carolina intends to improve community inclusion for people with disabilities. North Carolina’s Olmstead plan is also linked to the state’s commitment to provide more community-based programs under the Samantha R decision (see previous section). You can read more about the current and previous plans at NC DHHS Olmstead page here: https://www.ncdhhs.gov/about/administrative-offices/office-secretary/nc-olmstead.
Background: The Supreme Court’s Olmstead decision requires states to administer services, programs, and activities for people with disabilities in the most integrated setting appropriate to the person’s needs. States must have a plan in place to provide those services in the community for those who are eligible and seeking community placements.