Today The Arc of North Carolina formally releases our organization's position statement on a system design that will clearly address the real needs of people with developmental disabilities in our state.
The Arc of North Carolina's Position on Developmental Disability System Design was passed by our board of directors at our January meeting. It reflects our serious concerns about the direction our state is heading.
The position calls for Developmental Disabilities to be managed separately from Mental Health and Substance Abuse Services. In addition, The Arc calls for statewide management of the DD system. The position further states that if North Carolina is insistent on moving to Managed Care for the DD System, that it should only be done through a separate Developmental Disability specific 1915(b) waiver.
Though our organization has continually supported local systems management it is clear to us that the current movement toward Mega "Local" Management Entities running a Behavioral Health System is neither local, nor consistent with the values our organization holds.
The Arc of North Carolina
Position on Developmental Disability System Design
For too long North Carolina has attempted to run Mental Health, Developmental Disability and Substance Abuse Services through a one-size-fits-all system. This design limits the ability to create a cohesive vision. It obstructs the implementation of services and supports that are specific to people with developmental disabilities. In recent years the crisis in Mental Health (mental illness) services has substantially altered our system so that a “recovery” model has overshadowed the habilitative and support model valued by the developmental disability community.
Additionally, the reckless pursuit of a Behavioral Health Managed Care system threatens the core supports of people with developmental disabilities. The rush to turn Local Management Entities into Medicaid vendors of Prepaid Capitated Health Services is not only inconsistent with the Core Values of our organization, but it assures that North Carolina will no longer have a local management structure.
The Arc has consistently asked for North Carolina to manage its developmental disability system differently from the Mental Health and Substance Abuse system. Though many leaders have given lip service to such a plan no substantial coordinated action has taken place. The recent actions by DHHS and Local Management Entities indicate to us that continued integrated management will only amount to reduced service for people with developmental disabilities and a recovery oriented emphasis on supports that must be habilitative in nature.
The Arc wants a system that responds to the unique needs of people with developmental disabilities by providing support and habilitation in community settings based upon individual needs. We want a system that responds to the unique funding opportunities for people with developmental disabilities and rejects the behavioral health language of “recovery”. Our system should value and provide the choice to utilize self-direction options to those individuals and families interested.
The Arc believes our system must be fiscally responsive, efficient and accountable. Dollars appropriated for service should not be subject to duplicative administrative cuts. Providers should not be subject to duplicative monitoring. Families and people with disabilities should receive the supports necessary to live in communities but we must work toward a system that creates equity and efficiency.
Recommendations – North Carolina should:
• Create a separate Developmental Disability management structure within DHHS.
• Cease efforts to create additional 1915(b)(c) Managed Behavioral Health Care entities with developmental disabilities included
• Apply for 1915(i) State Plan services for adults with developmental disabilities targeting supports that currently utilize state general fund appropriations and utilizing those funds as Medicaid match
• If Managed Care is inevitable, consider a statewide 1915b Developmental Disability Only Managed Care Waiver with 1915i services included
• Add an additional CAP-DD Waiver for people with developmental disabilities who have significant behavioral and /or medical needs
• Raise the Supports Waiver limit to 25 thousand dollars
• Utilize the Supports Intensity Scale (SIS) as an initial eligibility tool for entrance into the CAP waivers with a reconsideration process utilizing other information
• Manage all of developmental disability services from a state system utilizing existing local structures where appropriate
The Arc wishes to work with all stakeholders to create a more effective, responsive and efficient system to support people with developmental disabilities and their families. We believe our proposal is sound and will meet these goals but welcome constructive conversation about these proposals.