Statewide foster care bill returns to NC Senate floor Statewide foster care bill returns to NC Senate floor

A plan for statewide foster care services, preferred by state health regulators, has reached the Senate floor for a second time after a series of clarifications were approved Wednesday by the Senate Rules and Operations committee.

The N.C. Department of Health and Human Services has proposed handling foster care services through the revamped House Bill 144, with the plan to debut by Dec. 1, 2023.

HB144 has been amended for what bill sponsors believe will resolve confusion about its intent.

However, bill opponents still don't like that counties - such as Forsyth - cannot opt out of the plan if it becomes law.

HB144, titled Medicaid Children and Families Specialty Plan, reached the Senate floor on June 8, only to be sent back to Health Care to address an amendment submitted by Sen. Joyce Krawiec, R-Forsyth.

Krawiec expects a Senate floor vote will be taken on HB144 this week. 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.

Krawiec said the amendment removes 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, she said.

The amendment also removes a limitation to allow entities with a common ownership to submit more than one bid.

Perhaps the most notable clarification is that a child cannot be taken out of the plan unless DHHS requests it, and federal Centers for Medicare and Medicaid Services approves it, because "they are doing it in the best interest of the child."

DHHS said in a statement that "we hope that all parties can work together to resolve differences so that we can move forward with this plan to meet the specific needs of foster children."

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 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 told the Rules and Operations members that "right now, we have a very fragmented system."

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

"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.

Behavioral health MCOs' primary purpose is overseeing 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.

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," wrote David Plyler, chairman of the Forsyth County Board of Commissioners.

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.

Among Vaya Health's counties are Alamance, Alleghany, Ashe, Stokes, Watauga and Wilkes. Among Sandhills' counties are Davidson, Guilford, Randolph and Rockingham.

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.

"It is a little confusing," Krawiec said last week in discussing the opt-out language.

"I believe there was a misunderstanding of what Dave said, but we have discussed at length. 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.

Kevin Leonard, executive director of the N.C. Association of County Commissioners, said in a statement Tuesday that "we applaud the rapid collaboration from the state's MCOs to develop a coordinated statewide strategy so that children and families who are in the foster care system have a seamless experience of quality care."

"The immediate and significant efforts of the NC Child and Family Improvement Initiative support the NCACC's request that DHHS pause implementation of a statewide plan, which would allow time for MCO results to be measured.

"It also would allow all stakeholders an opportunity to have dialogue that will assist in developing a long-term and sustainable solution to best serve the children in foster care programs across the entire state."

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