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Directors, NCSSA, NCACBSS,
The Advocacy Committee met today. The projections for April have been released
and the shortfall estimation for the year is an additional $283 million. We
met to prioritize the items that had been cut in the House that were restored
in the Senate. These items are very likely to come up in conference as possible
cuts in the final budget. For a list of the House and Senate conference members
go to: http://www.ncleg.net/gascripts/confcomm/confcommittee.pl?illChamber=H&BillID=397&session=2003
The budget items that were chosen to focus on as a funding priority are listed
in order of importance. Please review these and respond by 5:00 May 8th if
you would like to see changes to this list. I will tally up any changes that
come in and discuss it with the advocacy committee chairs. Friday morning
I will provide you with the final list the Association has adopted. We need
to move quickly on this as the Conferees will begin meeting immediately.
1. MAINTAIN Funding for Adult Home Specialist Fund / Adult Care Home
Case Management
Adult Home Specialist Fund
The House budget eliminates the state appropriation for this program from
$1,400,000 to $0. With this elimination of state funds the county DSSs will
no longer receive an allocation of state funds to provide this service.
Adult Homes Specialists in the county DSSs will be reduced from 133 to 91
positions. Workloads will increase from 14 to 25 facilities per worker. This
will significantly reduce the capacity of county DSSs to monitor the 1,300
adult care homes and family care homes with 39,000 beds for compliance with
state licensure standards, limit their ability to help facilities develop
corrective action plans when they are out of compliance with state licensure
standards, and reduce their ability to follow up to assure that facilities
correct deficiencies that affect resident health, safety, and well being.
The residents’ personal health and safety will be at greater risk.
Adult Care Home Management
The House budget reduces the state appropriation for this program from $1,539,206
to $539,206 for the next biennium. If the House budget is approved, this means
that the total budget for this program will be reduced from $6,156,824 to
$2,156,824. With this reduction in state funds, the allocation of state funds
to each county DSSs will be reduced by 66%.
Reducing the total budget from $6,156,824 to $2,156,824 will have a very significant
impact on the ability of county departments of social services to carry out
the duties required by state law and APA rules. This represents a 66% reduction
in the budget that will translate into a 66% reduction in counties’
staff capacity to do this work. The number of case managers will be reduced
from 70 to 24 statewide. This raises a serious concern about how the work
will be carried out. The $539,206 will be allocated to the 95 counties with
adult care homes, but it will obviously match only 33% of the amount currently
matched with the state appropriation. The logical outcome is that the service
cannot be provided to the same level of effectiveness and with the same timeliness
that it is currently provided. If this budget reduction is made, it will be
very difficult for the county DSSs to carry out the prior approval process
required by Medicaid for facilities to get the higher reimbursement for the
5,500 heavy care residents who get enhanced personal care services, to assure
that the heavy care residents are getting the additional hours of personal
care services the facilities are being reimbursed to provide, and for the
case managers to obtain the badly needed community-based services that improve
the quality of life and comfort for these residents.
2. MAINTAIN Medicaid coverage for pregnant women and infants w/incomes
between 151% and 185% of federal poverty ($22,530 for a family of three).
The House budget cuts Medicaid funding to women and children in this demographic.
The total cut is $2.185 million in 03-04 and $9.258 million in 04-05. The
Senate budget contains no such cuts.
This cut would eliminate Medicaid funding for 10,890 low-income mothers and
their infants.
3. INCREASE N.C. Health Choice by Senate Recommendation of $13M.
The House budget would increase NCHC funding by $7.7 million, maintaining
enough funding for 100,000 children.
The Senate budget would increase NCHC funding by $13 million in 03-04 and
$19.1 million in 04-05.
The NC Institute of Medicine predicts NCHC eligibility to increase to 105,000
in ’04 and 110,000 in ’05; the House budget would freeze out all
kids over 100,000 in both years.
The Senate budget would expand NCHC services to 105,000 kids in 03-04 and
110,000 in 04-05. Would also move children 0-5 with family incomes at or below
200% of federal poverty into Medicaid.
4. INCREASE Foster Care Rate by $50 for each age group.
The House budget includes a $3 million line-item to increase the foster care
reimbursement rate by $50 across the board. The Senate budget includes the
same allocation.
Originally, the House called for a $100 across-the-board increase; the house
had asked the legislative staff for the amount needed to cover this increase
but the figure was not accurate. When DHHS compiled the numbers they found
that the $3million state increase would only provide for a $50 increase.
5. MAINTAIN Medicaid coverage for 19 and 20-year-olds
The House budget would eliminate Medicaid funding for 19- and 20-year-old
foster kids, cutting a total allocation of $2 million for 03-04 and $3.5 million
for 04-05.
The Senate budget includes no such cuts.
Many foster children remain under care when they are 19 and 20 years old to
continue support that will assist them in finishing school, attending college,
and securing employment. This would eliminate health coverage for our foster
children during this critical transitional time.
6. MAINTAIN Transitional Medicaid coverage for those coming out of the Work
First program
The House eliminates the 12-month transitional period of coverage for those
coming off of Work First, cutting $412,322 in FY 03-04 and $21,235,628 in
04-05.
The Senate dropped this cut in its budget.
7. MAINTAIN Current rate of Prescription drug co-payment
The House budget cuts Medicaid prescription drug funding by $4.4 million.
The Senate budget includes no such cut.
The House budget would raise the Medicaid co-payment from $1 to $3.
