Groups sue state over foster care NAACP, Disability Rights NC sue state over foster-care placement services. Complaint alleges abuse, "warehousing" of children.
A federal lawsuit has been filed against state Health Secretary
The complaint was filed Tuesday in the
The plaintiffs pulled few punches in the complaint, accusing DHHS of a "pervasive, system-wide practice of unnecessarily warehousing children with disabilities in foster care in dangerous, locked psychiatric institutions - a harmful, unlawful practice that also falls most heavily on children of color."
"These children deserve and have the right to a family and place in our communities where they can meet their full potential,"
"Instead, they receive institutionalization and irreparable harm to their childhood and wellbeing."
DHHS could not be immediately reached for comment on the lawsuit.
The plaintiffs accuse DHHS of annually placing more than 500 foster care youths with disabilities in psychiatric residential treatment facilities.
The lawsuit cited as examples of dangerous conditions that the youths "regularly suffer from broken bones, sprains, bruises and dangerous physical and chemical restraints."
"They endure abuse, bullying and hate speech by both youth and staff, and receive strong cocktails of psychotropic medications instead of therapeutic treatment and care."
The plaintiffs said DHHS "is aware of these harms, yet continues to warehouse children in (those residential conditions) instead of building community-based placements and services."
"DHHS further compounds the harm by shipping significant numbers of youth in its care to other states as far away as
"The unnecessary use of these prison-like settings is both unlawful and widely recognized as harmful to youth, who fare far better when supported in family like settings in communities with supportive services," the plaintiff said.
The plaintiffs claim the effects of the foster-care housing environments linger beyond their youth.
"Some experience grave outcomes when they leave the system, such as homelessness and incarceration," the plaintiffs said.
"Black and Brown children in
The complaint points to DHHS data that found children of color make up more than 40% of the children on Medicaid confined to psychiatric residential treatment facilities.
Legislative approach
During the 2022 legislative session, a bill preferred by state health regulators cleared the
The Medicaid Children and Families Specialty Plan, a revamped version of House Bill 144, titled cleared the
Because
A rejection would have sent HB144, titled Medicaid Children and Families Specialty Plan, to a concurrence committee in an attempt to reach a compromise between the two chambers.
As of June, DHHS proposed handling foster-care services through a statewide plan set to debut by
However, bill opponents still don't like that counties - such as
About 218 young people in
Under the bill approved by the
Changes made 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. "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
"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
Opposition
HB144 and the plan is opposed by the state's six behavioral health MCOs and at least 30 counties, including
Among Partners' counties are
"The current CFSP proposal would transition many of the youth in
"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
MCO alternative
On
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
Some of the plan's components 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
* Establishing rapid access to care by reducing authorization barriers for residential treatment; and
* Increasing capacity for crisis care across the state.
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