Foster care plan easily approved by NC Senate Foster care plan easily clears NC Senate; fate in NC House unclear

A plan for statewide foster-care services, preferred by state health regulators, easily cleared the N.C. Senate by a 41-0 vote Thursday.

Because Senate bill sponsors, led by Sen. Joyce Krawiec, R-Forsyth, used the gut-and-replace strategy for House Bill 144, the House is required to either agree with the changes or reject them.

A rejection would send HB144, titled Medicaid Children and Families Specialty Plan, to a concurrence committee in an attempt to reach a compromise between the two chambers.

It's unclear whether such a compromise could be reached since House speaker Tim Moore, R-Cleveland, has said he is focused foremost on completing negotiations over the 2022-23 state budget before a projected end to the 2022 session in late June or early July.

Rep. Donny Lambeth, R-Forsyth, and the leading healthcare expert in the House, said after Thursday's vote that "we have two weeks before we adjourn. Thus, I do not believe there is time to take up these more complex bills that the Senate has worked on for months."

"Budget will be released next week and voting the last week of June and that will occupy most of our time."

"While House leaders have been wary of tackling major new issues during this short legislative session, this bill might prove to be a relatively easy lift," said Mitch Kokai, senior policy analyst for conservative think tank John Locke Foundation.

"It seems unlikely to generate the type of partisan battles that the House would like to avoid."

"If leading members of the House are aware of the legislation and support it, it's likely to pass."

The N.C. Department of Health and Human Services has proposed handling foster-care services through a statewide plan set to debut by Dec. 1, 2023.

However, bill opponents still don't like that counties - such as Forsyth - cannot 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.

About 218 young people in Forsyth have received foster-care services from its managed-care organization, Partners Health Management, since Forsyth joined on Nov. 1.

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

Changes made this week to HB144 remove a limitation on prepaid health plans that "will open the bids up for any qualified vendor." Any of the state's six behavioral health managed-care organizations are eligible to bid, Krawiec said.

Another change removes a limitation to allow entities with a common ownership to submit more than one bid.

HB144 details

Proposals for the statewide plan would be sought from prepaid health plans operated by health insurers who already have contracts with DHHS.

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

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

The goal is "to support family preservation, advance the unification of families, support the permanency goals of children, and support the health of former foster youth."

Key elements of 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.

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

They also play a role in ensuring that children in foster care are connected to proper health and medical care, along with other 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 Thursday. "They don't tend to talk with each other well."

The genesis of HB144's revamped language came from 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.

"These children go from one area to another and their insurance does not go with them," Krawiec said.

"With a statewide plan, they will have one (insurance) card, just like you and I, and they will be covered wherever they go in North Carolina."

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.

Among Partners' counties are Davie, Forsyth, Surry and Yadkin as members. Forsyth is by far the largest member by population.

"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, chairman of the Forsyth County Board of Commissioners, wrote to Richard in April.

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

"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 last week. "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 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."

On Tuesday, the MCOs provided new details on the initiative that included:

* 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 Dec. 1 launch of the N.C. Behavioral Health and Intellectual/Developmental Disabilities tailored plans.

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