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.