Response via email:
From: Dr. Patricia Porter, UNC adjunct Professor / DD and Policy Expert / hired Consultant to the NC General Assembly:
Hello Ms. De la Cruz-Hopper,
It was a pleasure to speak with you last week. As you know, Senator Hartsell and Representative Dollar asked that I contact you in response to the letter you sent to Governor Perdue and copied to members of the General Assembly. They were impressed with the comprehensiveness of your representation of your daughter’s status and the struggles you have had assuring that she receives the services and supports she needs as well as your concerns about issues that you have heard and read that may come from changes related to the statewide implementation of the Medicaid B-C Managed Care Waiver. You surely have done your homework and I believe you have done your best to become well informed about the changes to come in our MH-DD and SA system of services.
As you noted at the end of our conversation, there is a good bit of misinformation coming out about these planned changes and in some instances, an absence of factual information for families. As your own LME ( Wake) proceeds to prepare for the transition from a fee-for-services to a managed care operation, you are wise to make sure that you are being made aware of these plans and the potential impact of the changes. I understand that information and discussion opportunities are being planned and there is a request for questions currently posted on the Wake website. http://www.wakegov.com/humanservices/waiver/questions.htm
You may know that the session law (attached) directing the statewide expansion of the B-C Waiver has a number of specific provisions that require both the Department of Health and Human Services and the Local Management Entities to assure that the system is structured so that stakeholders, such as yourself, have meaningful knowledge of and input into the development of the new operation now and as it is established. LMEs have been conducting meetings with those receiving services and those currently providing services to discuss the changes and I hope you have been able to participate in those and in subsequent such meetings. Some of these forums have been conducted by the Jordan Institute for Families of the University of North Carolina School of Social Work under the direction of Professor Gary Nelson with a particular focus on the outcomes we hope to achieve with this system as they effect persons with disabilities and their families. The Department of Health and Human Services has recently established a Waiver Advisory Council http://www.ncdhhs.gov/mhddsas/providers/1915bcWaiver/index.htm comprised of stakeholders for the purpose of obtaining advice and council on the development of this new system. These meetings are open to the public and I would encourage you to attend and participate. There is an abundance of information about the B-C Waiver implementation on this website and you may want to take a look at the Strategic Plan listed there.
As we discussed, this is a significant change for the state of NC but a change that was deemed necessary by both the Department of Health and Human Services and by vote of the NC General Assembly. Transitions of this kind are necessarily disconcerting. While it is understandable that many individuals who have received services in the current system and some who have delivered those services would like the system to continue under its present structure, the decision was made that this is just not feasible. There are long waiting lists for service, some providers have not been of highest quality , some individuals and families have had to endure a revolving door of service providers with no reliability or consistency in service delivery, research has demonstrated that there is currently no relationship to the intensity of need of those who receive services and the services they receive. Some with relatively low need receive the highest cost services while many with very high need receive no services at all. In these lean budget times and with the pending changes in federal health care set to go into place in 2014, it is critical for the General Assembly, in concert with the DHHS and stakeholders to develop an accessible system that is of highest quality, responsive to the needs of people with IDD, MI, SA and their families and well managed to assure that both federal and state dollars are fairly and equitably allocated to the best benefit of the diverse population in need of services. Accountability is built in at every step with both internal and external evaluation of both program outcomes and expenditures. The General Assembly is committed to the development of this system with the meaningful input of individuals with disabilities and their families and with a foundation in evidence based outcomes. Your input and that of other key stakeholders is vital in assuring that the system achieves these intended goals.
I hope I was helpful as I answered your specific questions about the implementation of the B-C Waiver and its potential impact on services for your daughter and other people with IDD in our state. You suggested that you would like to develop a list of additional questions that we could discuss in a face-to-face meeting and I am happy to do that. Please let me know when you would like to schedule that meeting.
I look forward to speaking with you again.
Pat Porter
Patricia Porter, PhD, Consultant
From: Dr. Patricia Porter, UNC adjunct Professor / DD and Policy Expert / hired Consultant to the NC General Assembly:
Hello Ms. De la Cruz-Hopper,
It was a pleasure to speak with you last week. As you know, Senator Hartsell and Representative Dollar asked that I contact you in response to the letter you sent to Governor Perdue and copied to members of the General Assembly. They were impressed with the comprehensiveness of your representation of your daughter’s status and the struggles you have had assuring that she receives the services and supports she needs as well as your concerns about issues that you have heard and read that may come from changes related to the statewide implementation of the Medicaid B-C Managed Care Waiver. You surely have done your homework and I believe you have done your best to become well informed about the changes to come in our MH-DD and SA system of services.
As you noted at the end of our conversation, there is a good bit of misinformation coming out about these planned changes and in some instances, an absence of factual information for families. As your own LME ( Wake) proceeds to prepare for the transition from a fee-for-services to a managed care operation, you are wise to make sure that you are being made aware of these plans and the potential impact of the changes. I understand that information and discussion opportunities are being planned and there is a request for questions currently posted on the Wake website. http://www.wakegov.com/humanservices/waiver/questions.htm
You may know that the session law (attached) directing the statewide expansion of the B-C Waiver has a number of specific provisions that require both the Department of Health and Human Services and the Local Management Entities to assure that the system is structured so that stakeholders, such as yourself, have meaningful knowledge of and input into the development of the new operation now and as it is established. LMEs have been conducting meetings with those receiving services and those currently providing services to discuss the changes and I hope you have been able to participate in those and in subsequent such meetings. Some of these forums have been conducted by the Jordan Institute for Families of the University of North Carolina School of Social Work under the direction of Professor Gary Nelson with a particular focus on the outcomes we hope to achieve with this system as they effect persons with disabilities and their families. The Department of Health and Human Services has recently established a Waiver Advisory Council http://www.ncdhhs.gov/mhddsas/providers/1915bcWaiver/index.htm comprised of stakeholders for the purpose of obtaining advice and council on the development of this new system. These meetings are open to the public and I would encourage you to attend and participate. There is an abundance of information about the B-C Waiver implementation on this website and you may want to take a look at the Strategic Plan listed there.
As we discussed, this is a significant change for the state of NC but a change that was deemed necessary by both the Department of Health and Human Services and by vote of the NC General Assembly. Transitions of this kind are necessarily disconcerting. While it is understandable that many individuals who have received services in the current system and some who have delivered those services would like the system to continue under its present structure, the decision was made that this is just not feasible. There are long waiting lists for service, some providers have not been of highest quality , some individuals and families have had to endure a revolving door of service providers with no reliability or consistency in service delivery, research has demonstrated that there is currently no relationship to the intensity of need of those who receive services and the services they receive. Some with relatively low need receive the highest cost services while many with very high need receive no services at all. In these lean budget times and with the pending changes in federal health care set to go into place in 2014, it is critical for the General Assembly, in concert with the DHHS and stakeholders to develop an accessible system that is of highest quality, responsive to the needs of people with IDD, MI, SA and their families and well managed to assure that both federal and state dollars are fairly and equitably allocated to the best benefit of the diverse population in need of services. Accountability is built in at every step with both internal and external evaluation of both program outcomes and expenditures. The General Assembly is committed to the development of this system with the meaningful input of individuals with disabilities and their families and with a foundation in evidence based outcomes. Your input and that of other key stakeholders is vital in assuring that the system achieves these intended goals.
I hope I was helpful as I answered your specific questions about the implementation of the B-C Waiver and its potential impact on services for your daughter and other people with IDD in our state. You suggested that you would like to develop a list of additional questions that we could discuss in a face-to-face meeting and I am happy to do that. Please let me know when you would like to schedule that meeting.
I look forward to speaking with you again.
Pat Porter
Patricia Porter, PhD, Consultant
Health and Human Services
North Carolina General Assembly
301-B Legislative Office Building
300 N. Salisbury Street
Raleigh, NC 27603
(919) 301-1982
301-B Legislative Office Building
300 N. Salisbury Street
Raleigh, NC 27603
(919) 301-1982
