Thursday, December 8, 2011

Federal Judge Protects the Right of More Than 2,000 North Carolinians to Remain in Their Own Home


Contact: Vicki Smith
Executive Director
Disability Rights North Carolina
Phone (919) 856-2195

Thursday, December 8, 2011

Federal Judge Protects the Right of More Than 2,000 North Carolinians to Remain in Their Own Home

Raleigh, NC – U.S. District Court Judge Terrence Boyle today stopped the State of North Carolina from implementing policy on Medicaid personal care services that he said treats people with similar needs differently and puts North Carolinians “who have been successfully living in their own homes…at risk of segregation, in the form of institutionalization.” The Americans with Disabilities Act (“ADA”) prohibits the unnecessary segregation and unjustified institutional isolation of persons with disabilities. The State is required to provide federally-funded services in “the most integrated setting appropriate to the needs of the individual,” and the Medicaid Act requires that recipients not be treated differently when they have similar levels of need.

In his order granting a preliminary injunction and class certification, Judge Boyle found that plaintiffs offered sufficient evidence that the State’s policy on personal care services violates the Medicaid Act’s requirement to provide comparable services and the ADA’s integration mandate. The policy under review allowed individuals in facilities such as Adult Care Homes to be eligible for personal care services by meeting one set of eligibility requirements and required individuals in the community to meet a far higher standard of need. Under the policy, individuals who would not be eligible for personal care services while living in the community would get the care they needed by entering an Adult Care Home.

Judge Boyle also ruled the plaintiffs were likely to be successful on the claim that the letters sent to the plaintiffs to deny them services failed to comply with due process because the letters “contained verbatim language that failed to provide detailed reasons for the proposed termination” and that this was unlikely to be sufficient for a service that “could be quantified as a ‘brutal need.’” The Due Process Clause of the Constitution requires adequate notice be provided when a Medicaid service is terminated.

In granting the preliminary injunction and motion for class certification, Judge Boyle recognized that the “[l]ack of in-home PCS could result in either serious physical or mental injury or forced entry into institutional settings for many of the named Plaintiffs and members of the class….”

“We are thrilled with Judge Boyle’s decision. He confirmed our position that the State’s policy pushed people toward institutional settings,” says Vicki Smith, Executive Director of Disability Rights NC. “It is our hope that this decision will encourage the State to develop policies that articulate a clear priority to keep people in their homes and community. Such policies will be cheaper and lawful – a double win for the NC taxpayers.”

Plaintiffs were represented by Disability Rights NC, Legal Services of Southern Piedmont, and the National Health Law Program.

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Disability Rights North Carolina is the state’s federally mandated protection and advocacy system for people with disabilities and is a 501(c)(3) nonprofit organization with offices in Raleigh and Asheville. One of the P&A’s primary federal mandates is to protect and advocate against the abuse and neglect of people with disabilities.

Wednesday, December 7, 2011

Occupy Statement

NASW-NC has been working with our National office and many other state chapters to develop a position on the Occupy Movement. The following was approved by our state chapter's board of directors on Dec. 3rd.

National Association of Social Workers, NC Chapter
Position Statement re Occupy Wall Street

As an organization that is committed to social and economic justice and unimpeded access to services for all, the NC Chapter of NASW acknowledges the Occupy Wall Street movement. These protests serve to address America’s “new economy” as a tale of skewed wealth with declining wages, rising debt, and the risk of deep and persistent poverty for many.

Social Workers know that joblessness and economic insecurity contribute to the incidence of mental illness, family violence, suicide, substance abuse, crime, and diminished capacity for healthy family and community functioning. It is this knowledge and experience that gives the social work profession a special responsibility to advocate for income, employment, and social support policies that promote the economic justice and social well-being of all members of society. The NASW-NC Chapter supports social, economic, and political actions to end poverty.

(note: this document is based on NASW's public policy statement on social justice as it appears in Social Work Speaks and the NASW Code of Ethics.)

Tuesday, December 6, 2011

Mental Health Parity Law Brought No Cut in Benefits

Mental Health Parity Law Brought No Cut in Benefits
By Emily P. Walker, Washington Correspondent, MedPage Today
Published: December 02, 2011

WASHINGTON -- Most employers that offered mental health and substance use insurance coverage before the mental health parity law have continued to offer the same coverage, according to a new government report.

The report, from the Government Accountability Office (GAO), examined the extent to which employers provide mental health and substance use treatment to their employees and how that coverage has changed since the passage of the 2008 Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act.

That law requires that if a group health plan covers treatment for mental illness or drug or alcohol abuse, the limits and financial requirements for those services can be "no more restrictive" than those that apply to medical and surgical benefits. The law does not require employers to provide mental health and substance use coverage.
Historically, private health insurance plans had provided lower levels of coverage for mental illnesses than for physical illnesses.

According to the GAO report, from 2007 to 2010, about 38% of Americans older than 12 who needed treatment for substance use disorders didn't receive it because of lack of coverage and prohibitive costs.

The GAO surveyed 168 employers with at least 50 employees about their most popular health plans for the year of the survey and what the most popular plan was in 2008, a year before the mental health parity law went into effect. The survey also examined what sort of benefits were excluded in 2008 and not excluded in 2010.
In addition, GAO interviewed employers on why they added, changed, or eliminated mental health and substance use coverage after the passage of the law.
In all, 96% of employers who responded to the survey said they offered mental health and substance use coverage in 2008 and still offered it in their most recent plan year (either 2010 or 2011).

Just 2% of respondents said they nixed the mental health and substance use coverage in order to cut down on the costs of providing insurance to employees.
Employers reported covering the same diagnoses in 2010 that they did in 2008. Most employers reported covering five broad diagnoses -- mental disorders due to a general medical condition, substance-related disorders, schizophrenia and other psychotic disorders, mood disorders, and anxiety disorders -- in both 2008 and in 2010.

The most common change employers reported in their mental health substance use benefits from 2008 to 2010 was enhancing those benefits by removing limitations, such as the number of office visits allowed. A number of experts interviewed for the GAO report said it was common for employers to remove treatment limitations and annual dollar limits after the passage of the law.

The report also found that beneficiaries in need of mental health services generally paid lower-out-of-pockets costs after the passage of the parity law.
Most employers surveyed by GAO said making changes required by the law wasn't difficult.

However, it wasn't clear whether the passage of the law has had a positive impact on improving access for those with mental illnesses and substance use issues.
The GAO reviewed 30 studies on the issue, and 17 of those found that coverage or enhanced coverage through the parity law had an effect on access to or use of mental health and substance use services, while 13 studies found there was little or no effect.

Five studies found that plans with comprehensive coverage were linked with greater use of mental health services. For instance, one large company reduced copayments and made an effort to destigmatize mental illness, which led to an 18% increase in the likelihood of enrollees initiating mental health treatment.

And studies are just as varied on whether the mental health parity law has so far improved mental health, the report noted.

Thursday, November 10, 2011

NAMI Report:"State Mental Health Cuts: The Continuing Crisis"

NAMI North Carolina
Press Release
November 10, 2011
NAMI Report:"State Mental Health Cuts: The Continuing Crisis"

Contact: Jennifer Rothman, 919.788.0801 / 800.451.9681,

NAMI Report Shows NC Avoided Deep Cuts to Mental Health Funding
NAMI North Carolina Calls on State Leaders & Congressional Delegation to Protect Mental Health from Further Spending Cuts, Including 'Super Committee' Deficit Reduction

RALEIGH, N.C. (Nov. 10, 2011) - The National Alliance on Mental Illness (NAMI) North Carolina today announced that North Carolina ranks 24th among all states in terms of mental health care budget cuts made between fiscal years 2009 and 2012, according to a national report issued today by NAMI. In light of this new report, NAMI North Carolina urges the General Assembly and members of Congress to continue protecting North Carolinians living with mental illness from additional spending cuts, which will only exacerbate challenges to the mental health system.

"North Carolina's mental health system is at a crossroads," said NAMI North Carolina Executive Director Deby Dihoff. "While state leaders in North Carolina have worked hard to minimize cuts to mental health, the budget battles are far from over. We know that any further cuts will endanger our state hospitals and our community mental health system, which have both undergone tremendous turmoil and upheaval in recent years. We need a time of stability for the managed care approach to take hold and strengthen our system."

"North Carolinians need to contact members of Congress and state legislators to ask that mental health care be strengthened in the upcoming budget and protected from any cuts aimed at deficit reduction," continued Dihoff. "North Carolina's mental health care system is already at a breaking point, and if the congressional 'Super Committee' recommends further Medicaid or Medicare cuts this month, additional pressures will come into play. We can't balance the budget by compromising health care for our state's most vulnerable citizens."

According to the new NAMI report, "State Mental Health Cuts: The Continuing Crisis," North Carolina cut $7.3 million from state mental health care between fiscal years 2009 and 2012-a decrease of 1.2 percent. While the state made serious cuts to mental health spending, $48.2 million between fiscal years 2011 and 2012, the numbers don't tell the whole story. $45 million of those cuts were directed to the Local Management Entities, which were directed to take these one-time cuts largely out of their fund balances. Leaders in North Carolina made an effort to ensure that these cuts did not, in large part, affect service delivery. But North Carolina would like to join the majority of states, which increased their funding to mental health in the period from 2011-2012.

According to the NAMI report, during this same four-year period between fiscal years 2009 and 2012, South Carolina had the highest cuts totaling 39.3 percent of its budget, while North Dakota actually increased its mental health care spending by 48.l percent. See the report for full state-by-state data.

The NAMI report also outlines Medicaid pressures that threaten mental health care nationwide. Following the June 2011 loss of "enhanced" federal Medicaid matching funds that were part of economic stimulus legislation, states have had to fill the shortfall. North Carolina experienced an estimated loss of $343 million in enhanced funding. North Carolina's Medicaid program is now facing a nearly $140 million shortfall.

"We need to protect state and federal Medicaid revenues budgeted for mental health because for every dollar the state puts in, we receive two dollars from the federal government," continued Dihoff. "A recent report by the North Carolina Budget and Tax Center noted that if federal matching dollars are lost, it will cost North Carolina more than 13,000 jobs, and $613 million in labor income. State Medicaid funding means better health care for those with disabilities and a better economy."

NAMI North Carolina has developed a Public Policy Agenda outlining mental health priorities to guide state and federal policymakers as they make budget recommendations and consider funding allocations for mental health. NAMI North Carolina supports priorities that promote sustainable stability for North Carolinians living with mental illness such as additional community hospital beds and housing. To read the NAMI North Carolina Public Policy Agenda, click HERE.

The National Alliance on Mental Illness (NAMI) North Carolina is a grassroots non-profit organization providing support, education and advocacy for people living with mental illnesses and their families and friends. We are governed by a Board of Directors elected by membership and are 501(c)(3) accredited. NAMI NC is a part of NAMI which has over 210,000 members in 1,200 affiliates across the country. For more information, please visit

Thompson: Infant mortality rate threatened

The Daily Reflector
Greenville, NC

In a rare breath of good news, the governor’s office announced last week that North Carolina’s infant mortality rate in 2010 was the lowest in the state’s history. Fewer families endured the indescribable pain of losing a young child, a significant accomplishment for a state with a very poor track record preventing infant deaths. Unfortunately, the budget passed by state legislators last summer will likely undermine progress, particularly for eastern North Carolina and African-American families.
In 1988, North Carolina had the worst infant mortality rate in the country. Prodded by the shame of such a distinction, Republican Gov. Jim Martin and the Democratic state Legislature teamed up to implement a variety of public health programs to improve health outcomes for pregnant women and young children.
North Carolina’s infant mortality rate is now much closer to the middle of the pack in relation to the other 49 states.
The news, however, is not all good. African-American infants are still more than twice as likely to die as white babies, and eastern North Carolina counties suffer from disproportionately high mortality rates. This disparity will likely be exacerbated by the recent decisions of state legislators, who cut not only specific infant mortality prevention programs, but also broader health services for women and children.
Of specific importance to Greenville is the East Carolina University High-Risk Clinic, which serves as a regional hub for the treatment and support of high-risk pregnancies. In 2011, the Legislature chose not to renew the grant for the clinic.The elimination of state funding has led to the closure of two outreach clinics, the loss of key staff including the head nurse, and the doubling of wait times for patients. Since the success of prenatal services depends on providing the right care, at the right time and at the right place, these reductions in capacity and services will have a detrimental impact on infant mortality in the eastern part of the state.
Furthermore, the decision to cut the ECU High-Risk Clinic was penny-wise and pound-foolish. Just one pre-term birth is more expensive than the entire state allocation for the clinic, which was $325,000, a relatively small amount in a $19.7 billion budget. The cost of these preventable pre-term births will largely be shifted to the state’s Medicaid program, which was cut more than $350 million.
The Legislature’s budget decisions become even more troubling when the problem of infant mortality is viewed with an appropriately broad lens. After all, the infant mortality rate is a broad indicator of women’s and children’s health across the state.
In addition to prior pre-term births, diabetes and pre-existing health conditions are some of the major factors that lead to a high infant mortality rate. That’s why deep cuts to our state’s Medicaid program and the elimination of the Health and Wellness Trust Fund will have such a substantial impact on the infant mortality rate, especially in eastern North Carolina where rates of diabetes and obesity are already high.
We can do better. Gov. Martin, a Republican, and the Democratic legislature of 1988 showed that the two political parties can come together and prioritize the health and safety of North Carolina’s children. With the legislature back in session this week and again after Thanksgiving, it’s a perfect time for North Carolina’s current crop of elected officials to follow their example, put children first and fully fund the ECU High-Risk Clinic.

Rob Thompson is executive director of the Covenant with North Carolina’s Children, a coalition advocating policy that benefits children and families in North Carolina.

Sunday, November 6, 2011

Mental health services start fresh

by Kellen Moore

Tuesday was a fresh start for mental health services in Watauga County, as Daymark Recovery Services opened its doors at the sites of the former New River Behavioral HealthCare.

And on day 1, Daymark CEO Billy West had one message for clients and the community: “Bear with us.”

Although hundreds of details large and small were still being finalized even as business started Tuesday, Daymark staff reported a fairly calm transition.

“I think we're able to handle a lot of complicated things very well,” said Murray Hawkinson, site director for Watauga County.

Watauga County commissioners agreed Tuesday morning to lease former New River office space in the Human Services Building on the Poplar Grove Connector Road to Daymark for $5 per square foot per year.

With 13,775 square feet of space being used, Daymark will pay $5,739 per month in rent as well as $5,643 per month in janitorial and operating expenses, County Manager Deron Geouque said.

The rent is far below the fair market value of $10 to $12, but the board agreed to the reduced rate to minimize any disruption of services. The lease runs through June 30, 2012, and will be renegotiated then.

The rate is higher than the $3 per square foot that other members of the New River Service Authority board agreed to offer last week.

Inside the leased space, a skeleton crew was already operating Tuesday.

About half of the newly hired Daymark employees are attending orientation sessions Tuesday and Wednesday, and the other half will attend Thursday and Friday, West said.

The organization is still working to hire more physicians, and West said he did not know the exact number of employees that were in place as of Tuesday but was certain it was enough to keep the offices functioning.

In addition to staffing and space considerations, Daymark has been working to ensure that information technology systems are in place.

Computer systems and data lines are also being installed this week in the offices, West said, and Daymark also has had to purchase a new server to handle the data.

In a perfect transition, those data lines would have been connected and tested a month before the service provider opened, but Daymark didn't have that luxury, West said.

Telephone crisis lines are also continuing to function, although they may still refer to “New River Behavioral Healthcare” in automated messages for a while, West said.

West said all crisis employees have been instructed to continue as they have been until Daymark can address the crisis lines and services.

In Watauga County, 911 dispatchers had been answering New River's crisis lines after hours and connecting callers to the New River staff member on call, but Sheriff Len Hagaman told commissioners Tuesday he would like that system to end.

Commissioners agreed that the sheriff's office should continue answering the lines for the time being and directed Geouque to work with Daymark to find a new agreement.

With so many technology needs, Smoky Mountain Center has agreed to reimburse Daymark up to $370,000 to assist with the technology startup process, Smoky Mountain CEO Brian Ingraham said last week.

Although Daymark is covering the rest of its own significant startup costs at this point, West said he had “no problems” with the amount Smoky Mountain Center has provided to the organization.


While Daymark will provide the bulk of mental health services in the community, Smoky Mountain Center has also selected two other service providers to handle court-referred juvenile services and case management for people with intellectual or developmental disabilities.

True Behavioral Healthcare, based in Gastonia, hired 11 or 12 former New River staff members to start work Tuesday providing intellectual/developmental disability services.

In Boone, those employees are currently in the same space with Daymark employees until office space is arranged, True Behavioral CEO Carla Balestra said.

When IDD programs are up and running, True Behavioral plans to serve about 200 to 250 clients with an array of services, Balestra said.

Youth Villages is a national organization formed in Memphis, Tenn., in 1986 that will provide services to youth offenders and their families referred through the court system.

Sonja Luecke, a spokeswoman for Youth Villages, said the organization plans to begin helping youth by next week and started meeting some juveniles last week to assess their needs. Youth Villages does not yet have office space in Boone, but Smoky Mountain Center and the court are lending office space right now to conduct assessments, she said.

West said he was shocked to learn that Smoky Mountain Center would not select Daymark for the juvenile referral services and disappointed, as those enhanced services typically bring in revenue unlike many other mental health programs.

“What I told my staff was simply this: Am I surprised? Yes. Is this going to be the last thing that happens? No,” West said, adding that he felt there was too much to do to worry long about losing that solid source of revenue.

Luecke said court-involved youth and families can decide whether to follow their therapists to Daymark or use Youth Villages.

With dozens of decisions being made quickly and revenue streams still unknown, West said he is focused on ensuring that Daymark will not meet the same fate as New River.

“At the end of the year, we will have a system that may not be what you had yesterday, but it will be a system that will be sustained, and you will get a professional service for the long haul,” West said.

Durham-Wake Merger Would Create NC's Largest MCO

November 4, 2011

Durham, NC - A proposed merger between the Local Management Entities (LMEs) of Durham County and Wake County would create the state's largest Managed Care Organization (MCO) for public behavioral health and disability services based on population.

The Durham Center was selected by the NC Department of Health and Human Services to operate as an MCO under Medicaid 1915 (b)/(c) waivers effective January 1, 2013, serving Durham, Cumberland and Johnston counties. A merged Durham-Wake LME serving a four-county region including Wake would encompass a population of almost 1,690,000 residents.
A proposed merger agreement has been created and if approved by both parties, the merger would become effective July 1, 2012. The merged LME would begin managed care operations six months later. Durham County Commissioners will discuss the proposal on Monday, November 7 at their 9:00am regular work session.

The merged LME would be comprised of leadership and staff of both organizations with Ellen Holliman, currently Area Director of The Durham Center, serving as CEO. It would also have a new name and branding. Offices would be centrally located with satellite offices in both counties.

LME and other county government leadership from Durham and Wake have been engaged in discussions over the past year about how the two organizations could work together in some capacity. Significant similarities make The Durham Center and the Wake County LME logical partners for merger, with benefits anticipated for citizens, consumers, providers and taxpayers.

These include shared organizational values and missions and proven historical commitments to system of care philosophies and the use of evidence-based practices. The geographical proximity and similar urban compositions of the two counties create potential for pooling resources to address common challenges that can cause behavioral health costs to explode. Leadership and staffs of the two organizations have significant familiarity and existing working relationships with each other. In addition, there is major overlap of provider agencies serving consumers of both counties who frequently cross county lines.

"We are excited about the prospect of teaming with our colleagues in Wake County to help ensure that our citizens as well as those from Cumberland and Johnston counties receive the innovative, high-quality, recovery-focused behavioral health and disability services that result in positive outcomes," said Holliman. "We believe that all of our constituencies will benefit from the strength and viability that will result from the combined expertise and resources of the Durham and Wake LMEs."

For more information, contact Doug Fuller, director of Communications for The Durham Center at 919 560-7206.