Foster care measure re-filed in NC Senate New foster care bill filed in N.C. Senate. Forsyth Sen. Joyce Krawiec is the primary sponsor.

A group of N.C. Senate Republicans advocating for healthcare reform legislation have re-filed a bill that would make major changes to statewide foster-care services.

Those changes are designed foremost to ensure that a child in foster care retains access to Medicaid-covered physical and behavioral health services if they are moved to another county.

Currently, Medicaid services are handled by counties. That means when a child in foster care is moved to another county, a new application for services must be filed on their behalf with that county's Department of Social Services.

Senate Bill 156, titled "Medicaid Children & Families Specialty Plan," has Sen. Joyce Krawiec, R-Forsyth, as its primary sponsor.

The bill contains similar language to a House Bill 144, which cleared the Senate by a 41-0 vote in June.

However, with the priority at that time being passing the 2022-23 state budget, HB144 was not addressed by the House.

HB144 is the preferred option by state health regulators.

DHHS said in a statement Friday that the Children & Families Specialty Plan is designed to operate statewide "to enable children, youth and families to have access to a continuous, broad range of physical and behavioral health services regardless of their location in the state."

"NCDHHS conducted more than a year of robust stakeholder engagement with diverse participants including: youths and families; county leadership; providers; and numerous child, family and provider advocates."

Meanwhile, SB156 contains a significantly reduced role for the state's six behavioral health managed care organizations, known as MCOs.

The primary purpose of the state's six behavioral health MCOs is to oversee providers of mental health, substance-abuse disorder, intellectual and developmental disability and traumatic brain injury services.

They also play a role in ensuring that children in foster care get proper health and medical care, along with other services.

The behavioral health MCO serving Davie, Forsyth, Stokes and Yadkin counties is Partners Health Management. Forsyth is by far the largest of Partners' 14 members by population.

The six MCOs have introduced their own plan to assure statewide coverage that have drawn the support of at least 30 counties, including Forsyth.

"The goal is to provide continuity to families via a statewide foster plan," Krawiec said.

"We had hoped to get the foster care plan done and operational as a statewide plan, and the MCOs would transition to implementing the tailored plans."

Tailored plans delay

The launch of a key Medicaid initiative in North Carolina - tailored plans for behavioral health recipients - has been delayed twice from its planned July 1, 2022, launch. It is now scheduled to begin April 1.

Individuals who need certain services to address a serious mental illness, serious emotional disturbance, severe substance abuse disorder, intellectual or developmental disability, or traumatic brain injury may be eligible to enroll in a tailored plan.

DHHS said in July 2021 that tailored plans could serve about 200,000 North Carolinians, or about 7.4% of the 2.7 million Medicaid recipients in the state.

"Currently, we have the regional MCOs operating in silos,' Krawiec said.

"The population of foster care beneficiaries is very transient, and when they move from one region to another, their insurance does not go with them.

"The result is, the beneficiary is living in a region and their health care providers may be miles away."

Krawiec said SB156 will initiate a statewide plan so that beneficiaries "will not have their services disrupted."

"Their insurance coverage will be honored no matter where they are in North Carolina."

Bill changes

Changes removed a limitation on prepaid health plans that "will open the bids up for any qualified vendor."

Any of the state's six behavioral health MCOs are eligible to bid, Krawiec said.

SB156 also removed language that would require the MCOs to develop and maintain a closed network of providers to furnish mental health, intellectual or development disabilities and substance abuse services to its enrollees.

Another change removed a clause that would not have allowed entities with a common ownership to submit more than one bid.

DHHS would be responsible for determining which services would be offered in the plan and which Medicaid and N.C. Health Choice beneficiaries would be eligible to enroll.

The bill says those services would include: intensive in-home services; multi-systemic therapy; residential treatment; and services in private residential treatment facilities.

Key elements in both SB156 and HB144 would require the state's six behavioral health MCOs "to cease managing Medicaid services" for most foster care children.

The bill also would require area authorities to operate the plan under a contract with DHHS.

Background

The genesis of both bills was complaints expressed by county officials, including in Forsyth, about how Cardinal Innovations - once the state's largest MCO at 20 counties, but now disbanded - was overseeing foster care services.

Krawiec said that "right now, we have a very fragmented system" involving the six behavioral health MCOs

"Some are doing a good jobs and some are not," Krawiec said. "They don't tend to talk with each other well."

DHHS has proposed handling foster-care services through a statewide plan scheduled to debut by Dec. 1, 2023.

However, opponents of HB144 did not like that counties - such as Forsyth - could opt out of the plan if it becomes law.

Dave Richard, the state's deputy Medicaid secretary, has said the plan is expected to cover about 31,000 young people statewide through providers already participating in the state's Medicaid program. Richard will retire Tuesday after nearly eight years in that role.

At least 218 young people in Forsyth have received foster-care services from its managed-care organization, Partners, since Forsyth joined on Nov. 1, 2021.

Under HB144 and SB156, a child cannot be taken out of the statewide plan unless DHHS requests it, and federal Centers for Medicare and Medicaid Services approves it.

Blue Cross Blue Shield of N.C. supports the DHHS initiative as part of its Healthy Blue insurance coverage network.

"A single statewide health care plan can best manage the full range of benefits and services meant to address (youth in foster care), including crisis intervention, treatment and placement coordination," Blue Cross NC said.

"Through our Healthy Blue plan, we support the state's vision to transform the existing fragmented health care delivery model for youth and families involved with local Departments of Social Services into one that offers seamless, integrated, and coordinated physical and behavioral health care - including care management and placement coordination for children and youth in foster care."

Opposition

HB144 and the plan is opposed by the state's six behavioral health MCOs and at least 30 counties, including Forsyth, all of which say they want to keep foster care services as close to local as possible.

"The current CFSP proposal would transition many of the youth in Department of Social Services custody outside of Partners management, which would create another change too soon in an already complex system," David Plyler, then-chairman of the Forsyth County Board of Commissioners, wrote to Richard in April 2022.

Forsyth commissioners and DSS staff have expressed satisfaction with Partners' handling of foster-care services.

"The proposed single statewide plan design of the CFSP will jeopardize, rather than support, the progress we are making and targeted infrastructure we are building with Partners," Plyler said.

The six MCOs and the counties say they were told in April by Richard that counties can opt out of the plan contained in HB144.

"I believe there was a misunderstanding of what Dave said, but we have discussed at length," Krawiec said. "Counties could never opt out as a whole, but it can only be done on an individual basis."

Partners has said that "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 North Carolina counties who care for many of our most vulnerable children."

MCO alternative

On May 1, the six MCOs unveiled the N.C. Child and Family Improvement Initiative, which represents their collective first step toward providing an alternative to the proposed statewide foster-care services plan.

The initiative went into effect on Oct. 1.

The MCOs said a primary goal of the initiative is to demonstrate that their ability to "implement a statewide model to ensure seamless access to quality care for these children and families regardless of where they live in North Carolina."

The initiative would include:

* Creating a statewide provider network to ensure access to residential treatment and other services;

* Ensuring a standardized, seamless process for children moving from one MCO region to another or changing custody to a new Department of Social Services;

* Establishing rapid access to care by reducing authorization barriers for residential treatment; and

* Increasing capacity for crisis care across the state.

The MCOs expect "the immediate improvements resulting from this partnership will be fully functional" before the April 1 launch of the tailored plans.

[email protected]@rcraverWSJ