Legislative Update June 21, 2010

NCALA Advocates for Maximum Flexibility in Proposed Medicaid Waiver

NCALA is seeking changes in the Medicaid budget provision that deals with low-income residents in adult care homes. The House version of S897, 2010 Appropriations, contains a special provision to address this issue; the Senate plan included $5 million in funding alone. Both pieces are necessary in order for the plan to move forward to the Centers for Medicare and Medicaid Services' consideration. NCALA supports DHHS' efforts for the principals in this Medicaid Plan; however, recent DHHS-proposed changes have caused NCALA concern.

DHHS is seeking further modifications to the special provision and continues to seek Gov Perdue's recommended full funding of $9 million for the plan. NCALA disagrees with two points in DHHS's proposed changes. NCALA believes that the DHHS proposal, which would raise acuity levels to those in nursing homes, could disenfranchise some current residents. Furthermore, the DHHS proposal implies mandatory use of an assessment tool not supported by all adult care home providers. NCALA has offered conferees language to provide DHHS with the maximum flexibility to continue service to all low-income seniors in adult care homes and without reference to any particular assessment tool. NCALA believes that such flexibility would enable DHHS to craft a solid proposal without disenfranchising existing residents or mandating that private providers use a state-mandated assessment program, regardless of whether the providers participate in state programs.

Because of recent developments in federal budget deliberation, the likelihood of the conferees recommending the $9 million for the Medicaid plan is slim. The most recent proposal cut the Senate's proposed funding from $5 million to $4 million. NCALA has respectfully requested funding for the Medicaid Adult Care Plan at a level that satisfies CMS requirements, preferably no lower than $5 million.

NCALA encourages members to contact budget conferees to express concerns about the Medicaid plan and to ask for support for NCALA's proposed changes. To identify the conferees---or to identify your members of the General Assembly---please visit: http://www.ncleg.net/. That information is accessible on the front page of the site.

Budget Committees Confer—Federal Stimulus Funds Fate Uncertain

Senate and House Conferees on S897, 2010 Appropriations, continued to work in subcommittees according to subject area, largely behind closed doors. DHHS conferees struggled throughout the week of June 14, when a staff error revealed a $24-million mistake, raising the level of cuts to attain the budget target even more.

Foreshadowing the discussions in every area was the unresolved issue of whether the federal government will extend ARRA's (American Recovery and Reinvestment Act) increase in the Medicaid formula for the states (FMAP). Extension of the FMAP means about $500 million for North Carolina's budget. Late in the week of June 14, indications from Washington, DC, were that Congress would not approve the extension. This caused Gov Perdue and North Carolina legislative budget conferees to return to their spreadsheets to determine how to further adjust spending plans.

Without the ARRA FMAP funds, North Carolina's budget hole grows to $1.2 billion; on the other hand, lawmakers elected in Nov 2010 will have to determine how to live without those funds in 2011. At the end of the week, lawmakers continued with the budget work that was underway, but considered preparing a supplemental plan---one that would indicate how programs would be adjusted should the Congress decline extension of FMAP. Rumors circulated that departments, including Health and Human Services, could have additional budget cuts across the board of 3.5%. What makes this situation even more tenuous is that Congress's action could occur after North Carolina's legislators pass a final budget, which is why a contingency plan is so important.

NCALA continues to monitor budget progress. To read the entire budget proposal, please visit http://www.ncleg.net/. The latest versions of S897 and the corresponding money report are on the front page.

Summary of Recent Action on NCALA-Tracked Bills

Legislative Update June 4, 2010

House Approves Spending Plan—Next Stop: Conference Committee

During the week of May 31, the House of Representatives reviewed, debated, and amended its proposal to adjust the 2010 Budget, S897. The bill was approved in separate votes on June 3 and in the early hours of June 4.

As was reported earlier in the week, the House proposal does not provide funding for the NCALA-supported Medicaid 1915(c) waiver to address low-income residents with acuity that would otherwise place them in skilled nursing facilities. Instead, the House’s plan includes a provision directing DHHS to more fully develop the proposal and to report on it prior to submitting the application to the Center for Medicare and Medicaid Services for approval. The Senate proposal would provide $5 million for this purpose, while Gov Perdue recommended $9 million. A waiver would draw down federal funding, about $12.5 million under the Senate Plan and about $21 million under Gov Perdue's proposal, which would begin to address the long-underfunded services provided to low-income seniors in adult care homes. The item will be a point of controversy between the House and the Senate when the budget goes to Conference Committee. NCALA members are encouraged to contact their state Senators and Representatives to encourage their support of funding for the Medicaid 1915(c) Waiver. To identify your legislators, please visit: http://www.ncleg.net/GIS/RandR07/Representation.html

The House’s plan included a provision to preserve Medicaid funds for provider reimbursement, to the extent that funds permit. While the Secretary of Health and Human Services has the ability to make adjustments, the House’s proposal makes clear that provider reimbursements are to be preserved.

Like the Senate, House budget writers assume receiving an estimated $490 million from the federal government under a presumed extension of the FMAP formula through ARRA. Because indications are that Congress has not agreed to provide the funding in its budget package, this line item became a major issue of contention between members. If that funding issue is unresolved, it could lead to further, significant cuts throughout the North Carolina budget, especially in the Health and Human Services area.

To read the entire budget proposal, please visit the following link for information: http://www.ncleg.net/. The latest versions of the text of the bill and the money report are available below.

Aging Study Commission Proposals Clear Committees

Several bills that were recommended by the Aging Study Commission were considered by the House Committee on Aging on May 26 and by the Senate Health Committee on June 1.

Bills Approved by House Aging Committee May 26

H1692, Medicaid Dental/Special Needs Population, directs the Division of Medical Assistance and the Department of Public Health to study the dental services needs of special needs populations, including the elderly and developmentally disabled children. H1692 was approved by the Aging Committee and was referred to the House Health Committee.

H1693, Develop Special Needs Dental Care Workforce, directs North Carolina's Area Health Education Centers (AHEC) program to develop programs to coordinate workforce development to increase the number of dental care providers to serve the special needs population. The bill was approved and will be considered next by the House Health Committee.

H1698, Update Long-Term Care Statutes, would update and clarify the General Statutes on older adults and long-term services and supports. The bill would change the general tone of these statutes to place the emphasis on adopting policies to encourage and enable older adults to remain at home as they age. The bill would place programming emphasis on offering evidence-based activities to promote healthy aging, prevent injuries, and manage chronic diseases and conditions. Programming emphasis also would be placed upon encouraging individuals and families to plan for and finance their own future needs for long-term services and supports. The bill was approved and will be considered next by the House Ways and Means Committee.

H1703, Adult Day Care Criminal Record Check Process, would direct the Division of Aging and Adult Services to study the issue of criminal history record checks for current and prospective owners and staff---both volunteer and paid---of adult day care programs and adult day health services programs. The bill was approved and will be considered next by the House Judiciary II Committee.

Bills Approved by the Senate Health Committee

S1191, Nurse Aide Training Review, would direct the Division of Health Service Regulation to coordinate a review of the education and training requirements for nurse aides. The study would include a number of health care providers. NCALA has requested to be included in the study. The bill was approved and will likely be considered by the Senate during the week of June 7.

S1193, Implement LTC Partnership Program, would, in implementing the Long-Term Care Partnership, ensure that the state's long-term care insurance laws comport with federal law as amended in 2005. The bill is supported by the North Carolina Department of Insurance and the North Carolina Department of Health and Human Services and would enable and encourage more North Carolinians to purchase long-term care insurance in such a way as to minimize Medicaid estate recovery ramifications. The bill was approved and will likely be considered by the Senate during the week of June 7.

For more information about the North Carolina General Assembly, or to identify your legislators, please visit www.ncleg.net. For more information on these and other legislative issues, please contact NCALA, or Evelyn Hawthorne by e-mail: evelynhawthorne@nc.rr.com or by phone at (919) 523-9096.

© 2010 Evelyn Hawthorne Government and Public Relations

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