Parent Correspondence re CAP MRDD transition

Fwd: Waiver Update: CAP-MR/DD to IDD

---

MaryKShort@aol.com <MaryKShort@aol.com>	Tue, Sep 4, 2012 at 7:37 PM
To: MaryKShort@aol.com
This is about the CAP-MR/DD to IDD transition ... not NC Innovations or MCO's!  It looks like the change to the IDD waiver (and the 40 hour rule) will happen on Sept. 28th for those of you still on the CAP waiver.  Remember:  You have a right to request a reasonable accommodation or an exception to the 40 hour policy under the ADA (American with Disabilities Act.)  You simply request the ADA exception with the reason WHY you need the exception.  You also have a right to request an ADA reasonable accommodation or an exception to the SNAP/SIS score guideline/limit on the amount of services that are "medically necessary for health and safety."  Katie SNAP's at a Level 3 and received Level 5 Home Supports, exception was granted for her medically necessary for health and safety level of services.  You can request an ADA accommodation to any rule, policy, procedure or whatever.  Only you know what it is that will truly meet the "medically necessary for health and safety" level of services.   For those of you who switched to the IDD services way back when (November?) and who have been working more than 40 hours BECAUSE the state was not enforcing the limit because the waiver was not CMS approved ... It is my guess that you will now be required to come into compliance or request the ADA accommodation.   Mary K. Short 828-632-5888 or 704-451-4144 (cell) From: Connie.Martin@cms.hhs.gov To: MaryKShort@aol.com Sent: 9/4/2012 10:43:26 A.M. Eastern Daylight Time Subj: RE: Waiver Update: CAP-MR/DD to IDD Good morning, Ms. Short, Ms. Johnson left DMA a couple of months ago to take another position in the community according to the outgoing voice mail on her old telephone number.  At the end of June, CMS granted the NC DMA another extension to run until September 27th, 2012, so there have been no gaps in coverage.   CMS has recommended approval of the waiver renewal and it is going through the sign off process now.  Thank you, Connie  From: MaryKShort@aol.com [mailto:MaryKShort@aol.com] Sent: Sunday, September 02, 2012 7:26 PM To: Martin, Connie L. (CMS/SC) Subject: Waiver Update: CAP-MR/DD to IDD Hello Connie.  I wrote to NC DMA (Susan Johnson, below) asking about the CAP-IDD waiver and have not heard back.  A number of families have asked me I knew for SURE that the CAP-MR/DD to CAP-IDD waiver had been approved by CMS or if there was an extension.  In fact, DMA's web site only officially lists the extension to the end of June!  That would imply there is no CAP-MR/DD or IDD waiver.  Please let me know where it stands.  Thank you. Mary K. Short 828-632-5888 or 704-451-4144 (cell) From: MaryKShort@aol.com To: susan.e.johnson@dhhs.nc.gov Sent: 8/30/2012 1:47:23 P.M. Eastern Daylight Time Subj: CAP-MR/DD to IDD Is the MR/DD going to IDD on October 1st or not?  I can't find anything in a Medicaid bulletin or Update ... I only see IU #92 that said until 6/29/12.  What's up? Mary K. Short 828-632-5888 or 704-451-4144 (cell)

Legislative Correspondence: A Blast From the Past...

Mary K. Short is a strong and active advocate and the parent caregiver of an adult DD recipient with profound needs. She fights tirelessly for the rights of her daughter, Katie and other special families, as well as a great deal of time keeping folks informed! See below legislative correspondence regarding some of the same issues regarding DMA's 8M Clinical Coverage Policy from 2007. Posted with Mary's permission.


Mary and her daughter live in NC House District 88 and Senate District 42. Her daughter is being served by Smoky Mountain LME.

From: MaryKShort@aol.com
To:  Representative Nelson Dollar <nelson.dollar@ncleg.net>,
House Speaker Thom Tillis <Thom.Tillis@ncleg.net>
BCC: MaryKShort@aol.com
Sent: 5/30/2012 9:14:34 P.M. Eastern Daylight Time
Subj: 2007 email that is still timely!

Dear Speaker Tillis and Rep. Dollar:

I was "cleaning" old mail on my computer. Look what I found. I hope you both can see the ridiculousness of the NC Innovations Waiver having the same 40 hour policy that I was writing to you about in 2007 and I hope you can put an end to this ridiculous policy once and for all.

Additionally, I have received copies of the Public Comments that were made to DMA's Clinical Policy 8M CAP-MR/DD last June/July/August. There are over 500 comments. I have told you both before that only 1091 parents are paid to provide Home Supports out of the 10,000+ on the CAP-MR/DD waiver. It is astounding that most of those comments are families BEGGING DMA to not eliminate Home Supports. Yet, that is precisely what DMA did. It looks like about 500 out of 1000 felt strongly enough to actually WRITE an email. I already gave Sen. Daniel's LA (Andy) the Word documents from a thumb drive I brought with me to Raleigh today. (I only received the documents yesterday.) I am in the process of looking into a web site where I can post the documents and where they can be read rather than downloaded onto a computer. (My families will appreciate that!) I will send an email to everyone after I have that done. I also have to read ALL of it ... I skimmed all the pages.

Mary K. Short
828-632-5888 or 704-451-4144 (cell)
___________

From: Representative Nelson Dollar <Nelsond@ncleg.net>
To: MaryKShort@aol.com
CC: Legislative Assistant for Representative Thom Tillis <Tillisla@ncleg.net>,
Malcolmg@ncleg.net
Sent: 5/4/2007 11:38:27 A.M. Eastern Daylight Time
Subj: RE: DHHS/DMA - DD (not MH/SAS)

Dear Ms. Short,

Thank you for your e-mail and for sharing your personal experience. We will need to research were this legislation stands in the two Chambers, and any language or special provisions regarding these funds that may be in the House budget proposal. I appreciate having your "draft" proposal as a guide to your thinking on this issue.

My office will get back with you this coming week with an update on where this issue is in the legislative process.

Thank you again for your correspondence and your kind words.

Best Regards,
Nelson Dollar

Rep. Nelson Dollar
N.C. House District 36
Legislative Building, Suite 1209
Raleigh, NC 27601
919.715.0795
___________

From: MaryKShort@aol.com [mailto:MaryKShort@aol.com]
Sent: Mon 4/30/2007 11:02 AM
To: Representative Nelson Dollar
Cc: Kristen Feneley (Rep. Tillis); Sen. Malcolm Graham
Subject: DHHS/DMA - DD (not MH/SAS)


Dear Mr. Dollar,

I am writing to you in order to ask for your help with legislation regarding the DD community. I am sending copies to my Mecklenburg representatives and am asking that you all work together to help. If it is at all possible that any of you disagree with what I am asking, would you please at least respond with your reasons why? Please.

Mr. Dollar, I have seen you a number of times on UNC-TV Legislative Week in Review and feel I have gotten an understanding of your interests in general and in DD (developmental disability) and mental health issues as well. I did see that you have sponsored specifically H 674 and therefore feel comfortable that you have an understanding of the DD community.

Mr. Tillis, you were kind enough to meet with me and my daughter in Cornelius for over an hour back in February to discuss my concerns with what was happening in the CAP-MR/DD waiver program. Mr. Graham, I regret to say that you and I have not spoken other than at an initial meet the candidates evening at Davidson's Town Hall years ago!

I am asking for help to stop the proposed Technical Amendment to 1915 (c) CAP-MR/DD Waiver dated 3/2/07 (http://www.ncdhhs.gov/mhddsas/ and then click on What's New to see "The New Technical Amendment No. 4 ..." which will take you to the CAP-MR/DD pages. Specifically, Services and Supports Provided by Legally Responsible Individuals, Relatives, and Legal Guardians, Appendix B-2, Attachment 1.

I was hoping you could look at my proposed "DRAFT" and determine if there was a way to amend a pending bill (such as Sen. Shaw's S 1188) to include some/all of the language in my "DRAFT" ... I am just a parent of an ADULT Medicaid beneficiary, a private citizen, and if Technical Amendment No. 4 is implemented, then I will have no choice but to go to the Clerk of Courts and resign my guardianship. A new guardian will then need to be appointed and that new guardian had better get busy, because my daughter will no longer be able to live in my home. I simply cannot watch her be abused by "staff" AGAIN and especially not IN MY HOME. The truly crazy thing about Technical Amendment No. 4 is that is does not SAVE one Medicaid penny and it does not prevent a stranger from working more than 217 hours! My daughter's plan of care is what is funded, not her family! The services are going to be paid for whether I receive the paycheck or some stranger (or combination of strangers) does. And I just refuse to teach her to have "appropriate" behavior while she is naked in front of constant rotating staff! And I refuse to interview and train staff for FREE. I volunteer all the hours that are NOT funded now ... my ADULT daughter requires 24 hour staff, 7 days a week, 365 days a week ... she simply is someone who forever and always will be in the care of others.

DRAFT

Whereas, the General Assembly of North Carolina acknowledges the federal Centers for Medicare and Medicaid Services definition used for State Plan Medicaid services can be found at State Plan Manual:

4480. PERSONAL CARE SERVICES

D. Definition of Family Member. -- Personal care services may not be furnished by a member of the beneficiary's family. Under the new final rule, family members are defined to be "legally responsible relatives." Thus, spouses of recipients and parent(s) of minor recipients (including stepparents who are legally responsible for minor children) are included in the definition of family member. This definition necessarily will vary based on the responsibilities imposed under State law or under custody or guardianship arrangements. Thus, a State could restrict the family members who may qualify as providers by extending the scope of legal responsibility to furnish medical support."


Whereas, the General Assembly of North Carolina acknowledges that the Centers for Medicare and Medicaid Services allows States to extend the scope of legal responsibility to furnish medical support,

Whereas the General Assembly of North Carolina acknowledges that the Centers for Medicare and Medicaid Services allows states to enact further specific State Plan and/or 1915(b)(c) Waiver definitions,

Now, therefore,

The General Assembly of North Carolina enacts:

Section 1 (I do not know, but is a number). Chapter (again, who knows, but it is a number) of the General Statutes to read:

The General Assembly adopts the federal Centers for Medicare and Medicaid Services definition of "family member" as written for Medicaid State Plan and 1915(b)(c) Waiver services and specifically does not extend the scope of legal responsibility to furnish medical support or authorize the Secretary of Health and Human Services to enact any rule or policy that would change the definition or extend the scope from the federal Centers for Medicare and Medicaid Services definition or scope.

SECTION 2. Nothing in this act shall require the General Assembly to appropriate funds to implement it or require a local management entity to spend additional funds to implement it. The provisions of this act are not intended to create a burden, financial or otherwise for the Department of Health and Human Services or local management entities.

SECTION 3. This act is effective when it becomes law.

Okay. That is my DRAFT. I am trying desperately to take away the current power of the Secretary of DHHS to take my daughter away from me simply because she is POOR and is DEPENDENT on Medicaid tax dollars. I have documented proof of the abuse she has suffered at the hands of others here in North Carolina ... please, please, respond.

Mary K. Short
P.O. Box 1994, Davidson, NC 28036
704-896-5735

from CMS re Comprehensive & Supports Waivers

From: Connie.Martin@cms.hhs.gov
To: MaryKShort@aol.com
Sent: 6/6/2012 10:00:59 A.M. Eastern Daylight Time
Subj: RE: Follow-Up re CAP-IDD waiver

Dear Ms. Short,

The CAP-IDD waiver (a.k.a., NC 0662, Comprehensive waiver) is not yet approved. We continue to work with the State toward getting the waiver approved.

We are also working with the State to get the NC 0663, Supports waiver for MR/IDD individuals approved. NC 0663 has the same extension date as the Comprehensive waiver. As you probably already know, the Supports waiver provides services for those individuals who needs are less severe than the individuals in the Comprehensive waiver.

Thank you,
Connie

From: MaryKShort@aol.com [mailto:MaryKShort@aol.com]
Sent: Tuesday, June 05, 2012 6:39 PM
To: Martin, Connie L. (CMS/SC)
Subject: Follow-Up re CAP-IDD waiver

Hi Connie. Here it is the beginning of June and we are all wondering (AGAIN - not your fault that our DMA does not let anyone know anything) if the CAP-IDD waiver is approved? We all know there is an extension to 06.28.2012. Thank you.

Mary K. Short
828-632-5888 or 704-451-4144 (cell)

email to Pat McCrory & Twitter

As we all should, I prefer to be an educated voter and have a good understanding of not only the issues at hand, but the political positions on those issues that matter most. So I'm following lots of folks these days and Twitter, as annoying as it is, comes in handy. 

As a parent of a child with profound Developmental Disabilities and Medicaid / CAP recipient, it goes without saying that I am very interested in candidate positions on DD / Medicaid / DHHS matters that will impact Isabel, our family & lots of special peeps across the state - as I'm sure most special parents, providers, and direct-care-staff staff are.

If you Tweet, feel free to follow me as that'll pretty much be my focus 'til the end of this thing - with maybe an occasional coffee picture thrown in, only because to my knowledge caffeine does not come in an IV drip yet.  

*Please note: re-Tweets and Follows are not necessarily endorsements, but they could be?

Email to Pat McCrory, 

Candidate for NC Lt. Governor

Pat McCrory (@PatMcCroryNC) has sent you a direct message on Twitter!

Crystal J. De la Cruz Tue, May 22, 2012 at 2:06 AM

To: info@patmccrory.com, media@patmccrory.com, volunteer@patmccrory.com, rdiaz@patmccrory.com

Dear Mr. McCrory,

I, along with many parents and family members across the State, would eagerly welcome a dialogue and are very interested in your position regarding the new state-wide Medicaid 1915(b)(c) Waiver reform and the vital impact the service cuts will have on Developmentally Disabled citizens and families.

Many of the members of the North Carolina General Assembly who sincerely wish to assure that the welling wellbeing of our most fragile of populations receive the proper supports and protections, despite their best efforts, are not receiving the most complete information from all stakeholders necessary to make the best possible decisions for all involved. True, it is not an easy system to understand, even for those who live and work in it. --All the more reason that after so many proven failures, we slow this train down, get it right, and make certain that we arrive at the destination intended. --All the more reason that those who will be most affected by these decisions and changes - the innocent and vulnerable developmentally disabled children and their overwhelmed and exhausted families - have a voice and that voice be heard.

Currently, our voice is NOT being heard. 

Currently, there are no appropriate appeal procedures in place for families regarding the care of their special loved ones and the hope of fail-safe due process protections are in dire jeopardy.

For your review, I have attached the letter and enclosures previously sent to Governor Beverly Perdue and members of the General Assembly earlier this year. To the best I can confirm, it was never personally read by our Governor. From the 170 members of the House and Senate, I received 5 responses to my initial mail.

I look forward to hearing more on your position and invite you to please contact me at any time.

Thank you in advance for your time an attention on behalf of my daughter, Isabel, my family, and the thousands of special populations across the State of North Carolina and the families who love them.

Sincere regards,

-- 

Crystal J. De la Cruz - Hopper

Mother, Advocate & Concerned Citizen

[Phone] Office

When we allow the value of human life to be determined by capital gain, when we sacrifice the well-being of the most innocent among us to compensate our own shortcomings, and when we judge the worth of our most fragile, not by their character nor intention, but rather their abilities – We Are in Crisis.

http://no2nchb916.blogspot.com/

"The moral test of government is how it treats those who are in the dawn of life . . . the children; those who are in the twilight of life . . . the elderly; and those who are in the shadow of life . . . the sick . . . the needy . . . and the disabled." 

--Hubert H. Humphrey

---------- Forwarded message ----------

From: Twitter 

Date: Tue, May 22, 2012 at 12:36 AM

Subject: Pat McCrory (@PatMcCroryNC) has sent you a direct message on Twitter!

To: Crystal J. De la Cruz

Thanks for the follow. I look forward to the conversation. Hope you will sign up on my website: patmccrory.com. Direct message sent by Pat McCrory (@PatMcCroryNC) to you (@delacruzhopper) on May 21, 11:36 PM. PatMcCroryNC Pat McCrory

Send a message to @PatMcCroryNC Want to receive mobile notifications?Download Twitter for your phone »

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Years of CAP Service vs. No. of CAP Workers

I posed a question today in the Facebook group, "For those receiving CAP services: How long have you received services?... and to the best of your recollection, how many CAP workers have been employed to work with your child in that time?"

Responses:

• Crystal (me) = 19 CAP employees over 10 years
• JC. = 2 CAP employees over 7 years
• PF. (child 1) = 6 CAP employees in less than 3 years
• PF. (child 2) = 6 CAP employees in less than 3 years
• CT. = 23 CAP employees over 8 years
• LB. = 3 CAP employees over 3 years
• BF. = an estimated 50 CAP employees over 7 years
• TH. = 5 CAP employees over 7 years
• SG. = 9 CAP employees over 5 years
• LW. = 6 or 7 CAP employees over 2 years
• AC. = approximately 15 CAP employees over 5 years
• RB. = 3 CAP employees in 3 years
• KF. (child 1) = 9 CAP employees in 7 years
• KF (child 2) = 12 CAP employees in 6 years

Can you guess the lucky exception? 

Care to speculate the reasons behind such extreme turnover rates?

The implementation of the new 1915(b)(c) Medicaid / Innovations Waivers and the service cuts it brings, will steepen and compound the improbabilities of finding and retaining reliable, trustworthy and professional direct-care staff to aid in the care, supports and life-skill goals of our children. 

While for most families, the bulk of service hours allotted will remain in the same ballpark, many others will have their hours cut due to a maximum ceiling, irrespective of individual level of need. Of the total service hours for an individual recipient, much of those hours will be shifted from the  higher paying Home and Community Supports (HCS) rate to the much lower Personal Care Services (PCS) rate, essentially resulting in a very substantial pay cut (in some cases, nearly half a worker's salary) for direct-care staff who already make less than peanuts for the important and vital work that they do - and with no benefits.

From my letter to Governor Perdue:

In the last 10 years, I can recall no less than 19 CAP Workers / care providers to whom I have entrusted my helpless little girl; I cannot even remember all their names as the turn-over rates for these positions is quite high. (In special parent circles, a CAP Worker who sticks around past one year is Gold.) Consider the emotional and developmental damage that such constant inconsistency creates in the daily life of a child with special needs; learning a new person, loving a new person, and losing that person – over and over again (never mind what it does to the parent). And while there have been some wonderful trustworthy care providers in our life, I wish that were the only issue... During this parade of CAP Workers, practical strangers in my home and personal space, I have experienced: the physical abuse of my child when an employee pinched my 3 ½ year old numerous times leaving dark purple and green bruises on her tiny body, thousands of dollars worth of property stolen from my home, and a week’s worth of groceries devoured that I could not afford to replace; I had an employee who took my daughter on a date with her ex-husband she’d previously had a DVPO against who was unaware she was living with a new guy; I once had two employees who became friends and later found that they spend quite a bit of time hanging out together in bars smoking and drinking with my child in their care; one girl who was fired for drug abuse; and last but not least, yet another who filed a DSS complaint against me for “abuse and neglect” in retaliation for being terminated – an incident that wasted the time and resources of 5 separate agencies, including the Morrisville Police Department, Cedar Fork Elementary School, Wake County Human Services, and the Department of Social Services. And that’s just the stuff I know about; anything else that has happened throughout the years, my daughter is unable to tell me. 

During the last Bush Administration, the federal Medicaid reimbursement rate was cut by eight dollars ($8.00) per hour, a significant amount when one considers the cost of overhead and employee salaries. Today, the average CAP Worker makes between nine to twelve dollars ($9.00-12.00) per hour when performing “Home and Community Supports” (HCS) services (this is the minimal time designated for working on pages and pages of specific life-skill goals and continuation of therapies, not unlike an IEP) and minimum wage to eight dollars ($7.15-8.00) per hour for “Personal Care Supports” (PCS) services (the bulk of allotted hours which includes bathing, grooming, toileting, etc.) and “Respite” (time built in for unscheduled relief). Comparatively, a Certified Nurse Aide 1 working in a long-term care environment in Wake County makes roughly $13.03 hourly, while a Wake County Teacher Assistant in Special Education averages $10.27 per hour and a Wake County Public Schools Custodian, $12.80 per hour, not including benefits or shift differential. For the record, the average Garbage Collector in the State of North Carolina is paid an average hourly rate of $11.75. A CAP Worker receives only their hourly wages with no benefits whatsoever when working consistently less than 30 hours weekly, not even mileage reimbursement to offset the cost of driving their clients around in their personal vehicles attending community activities as dictated by their care plan.

Suffice it to say that the vast majority of families not utilizing the maximum amount of service hours allotted are not choosing not to do so because the need is not present. Quite the contrary, there is a critical need that cannot be staffed with competent, quality, reliable, professional care providers dedicated to a profession that includes a daily routine of cleaning feces, urine, and vomit; preparing special foods and feeding; heavy lifting; changing G-tubes and catheters and diapers; administering medications; bathing and dressing; utilizing sign language and specialized communication devices; and completing endless amounts of paperwork tailored to a non-applicable medical model to justify their existence all while being subjected to nerve-racking and often abusive behaviors such as hitting and biting, because frankly, people can make a better salary emptying garbage cans than caring for an innocent human being unable to do for themselves.

* If you would care to share your stats regarding years your loved one has received CAP direct-care services and the number of CAP workers that have been employed in your home to care for your child, likewise any related stories regarding difficulties in direct-care coverage, experiences, etc. please feel free to respond to this blog post, post in our Facebook group or contact me privately via no2nchb916@gmail.com.

Wake Forums: CAP Services

In text...

Community Forums (from Alliance Behavioral Healthcare): Services for People with Intellectual / Developmental Disabilities with the Merger and 1915 b/c Waivers 

To be held:

Wake County Commons Building
4011 Carya Drive
Raleigh, North Carolina 27610

Wednesday, May 9, 2012
Focusing on those with CAP MR/DD services

12:00-1:30 pm or
5:30 - 7:00 pm

Monday, May 21, 2012
Focusing on those waiting for services, or those receiving Medicaid TCM or State-funded services

12:00-1:30 pm or
5:30 - 7:00 pm

Alliance Behavioral Healthcare is a new multi-county Area Authority merging The Durham Center and Wake LME. For more information on the merger or these forms, visit www.durhamcenter.org. 

Mental Health Reform 3.0

I recently learned of a talented and very ambitious research journalist and UNC student, Lydia Wilson, who chose (yes, chose) to focus on North Carolina's Medicaid Waiver for her master's thesis. 

In her email below, she states that she's "especially interested in human stories of what this system is and why it matters"... A focus on real people? What a novel idea!

Whether you're a parent, provider or any interested stakeholder affected by the new waiver changes and have a story to share, I encourage you to contact Lydia. If you need an introduction, please contact me via no2nchb916@gmail.com.

Lydia's email:

I've just published "Mental Health Reform 3.0," the multimedia news website about North Carolina's Medicaid reform for which I interviewed you recently (or read your writing, blogging, reporting, etc...). This was started as my Masters thesis for the School of Journalism at UNC-Chapel Hill. I'm writing to thank you for your time contributing to the reporting and invite your feedback.

The website can be found at http://www.ncmentalhealthreform.com. At its core are four text articles, called "Reform 101," explaining the story of how N.C.'s reforms to the services for people with mental health or substance abuse disorders or intellectual or developmental disabilities came to be and where they're going. You'll also find an interactive timeline of the reforms, a glossary of key terms, graphics explaining certain issues and personal stories of those affected by the policy.

I will continue covering news of North Carolina's Medicaid reform through 2013 at least. So, please do call or email if there's something that is not covered that should be.

I'm especially interested in human stories of what this system is and why it matters. From policy makers to consumers, if you know people who want to share their story, please send them my way.

I hope you'll excuse the formality of this group email. But it's in part because so many people gave so much time, information and perspective. I appreciate your time sharing your story and hope you'll continue to do so.

As a last note, Rose Hoban of North Carolina Health News has been doing an immense amount of reporting about these reforms and the broader context of healthcare and policy in our state. Follow her site for comprehensive journalism, as well: http://www.northcarolinahealthnews.org/  

Parent Perspective: THE Letter

"THE Letter"

Note: Script of the letter posted below or download the letter and enclosures in its entirety.

February 23, 2012

After several months of research and writing - and a minor 'set-back' involving medical drama when my daughter was diagnosed last month with Type 1 Diabetes - it is done! I have begun to refer to this project, not-so-fondly, as THE Letter.

THE Letter has cost me much sleep and sanity, time I will never get back, many phone calls and emails with various helpful and knowledgeable parents and professionals (you know who you are and you have my eternal thanks!) and arguments with my tired, but very supportive, husband who has picked up all the slack I've left behind. Whether or not it has been worth it, remains to be seen, though as a mother of a special, magical little girl, I simply don't know how to do any differently.

Last week, when I hit the final key stroke and realized with amazement and relief that it was indeed, at long last, finally done, I had to read it to someone or I was going to burst. I called my friend and case manager, a jewel amid jewels (a woman who has already gotten heat for the numbers of appeals she has filed on behalf of her recipients for services under the new Waiver plan); she listened quietly and cried through the whole thing. When I finished, she said simply, "Crystal, that is a work of art!"

I'm not trying to toot my own horn here, really I'm not. Yes, I seem to have a knack for this stuff but truthfully, I don't even feel as though the words came from me. I asked for the perfect words and this is what came. I just feel that I did what I had to. What I always do, for the sake of my child and her special peers...

She asked if she could forward it; I told her that when the proverbial cat was out of the bag, she was welcome to send it anywhere she wanted with my blessing and gratitude. Then she said something that really choked me up: "You have no idea what this letter is going to mean to other parents... they are so tired and confused, most have just given up..." 

And that is why I started this blog.

THE Letter goes out tomorrow to Governor Perdue, Friday, February 24th. I will post the 128 page pdf version of my letter and enclosures in it's entirety on Monday evening. 

Why 128 pages? Well, in addition to the 10 page letter, 1 page list of enclosures, and 4 pages listing copied recipients, I am including photos, an article I wrote while employed at FPG Child Development Institute UNC-CH (which now appears in the textbook, Educating Exceptional Children), and 'a small sampling' of my daughter's paperwork that I'm certain most of these folks making the decisions about our children's lives  and services have never seen (the ones we get sick of looking at) - the paperwork that represents my daughter to the state and to Medicaid. As I have quite the long list of recipients, I will be distributing those in days following.

I plan to also post, the personal enclosure letters I send to key members of legislature as well as any correspondence I receive in response.

23 February 2010 2012

Via US Mail and Facsimile # 919-733-2120

Governor Beverly Eaves Perdue

Office of the Governor
Constituent Services Office
116 West Jones Street
Raleigh, North Carolina 27603

Re:     2011 North Carolina House Bill 916 

A Desperate Plea for Help.

Dear Governor Perdue,

Many years ago, I attended an advocacy presentation on Developmental Disabilities at the William and Ida Friday Center for Continuing Education at The University of North Carolina at Chapel Hill. I was a single parent then of a beautiful developmentally disabled child with profound special needs and worked at the FPG Child Development Institute. –I deeply regret that I cannot recall in this moment precisely which of the numerous disability advocacy and special education events this was (you see, I have attended so many over the years as a special parent and advocate fighting for the rights of my child) but I do remember vividly the speech the keynote speaker gave that day:

She told us about a member of her family, a sweet, loving developmentally disabled girl and how she was once shoved in a trash can by her very own teacher, discarded as garbage, by the one person who should have protected her, supported and encouraged her, set the example and sent the message to her peers that this child was precious too. (I think she may have even wiped away a tear; I know I did.) She told us how that had impacted her greatly such that the rights of the developmentally disabled community would always be a personal priority for her. She told us how we, as parents, advocates and teachers, inspired her and though, as a society, we’d come so far from those days her relative endured, the road was yet long. She said, ‘No child should ever be thrown away.’

That speech was powerful, emotional, motivating and imbuing of hope.

My daughter, Isabel, has a one of a kind genetic rearrangement never documented prior to her birth; she is the only one. Last month was her 14^th birthday and while most girls her age are painting their nails and texting boys, Isabel remains socially / emotionally a non-verbal, incontinent toddler, complete with pull-ups and tantrums.

To the State of North Carolina, the NC Department of Health and Human Services, the Division of Medical Assistance, and Medicaid, my daughter is represented by the small sampling of papers beneath the words you read now, absent hoards of medical records. I would like very much to tell you what an awesome, magical little person she is, how sweet and mischievous, and how she adores her 5-year-old ‘big little brother,’ Liam; I’d love to tell you what a strong personality she has and about her fantastic sense of humor, and how, in her short life, she has been my greatest teacher. —Though instead, I am writing now to share with you the details of our life, because as her mother, this is how I love her…

For over 7 years, I struggled as a single mother and sole provider. I worked full time, paid bills, owned my own home, and shopped for groceries when I could afford them. I cooked, cleaned, cared for my child, dressed her, and have wiped her bottom every day of her life. I’ve carted her around continuously to doctors, specialists, and therapists, attended countless Individual Education Program (IEP) meetings, seminars, and workshops, and have been a strong and active advocate for my child and others over the years, enlisting the aid of senators and congressmen when necessary. I have served on boards for non-profit organizations, written published articles, taught other parents, fought for support for Special Education teachers, volunteered my time when I could, and have never once received public assistance. Even through a major back surgery and an ugly divorce, I did what I had to do because I had no choice; my daughter needed me to be that strong. But I could not have survived, could not have done any of it, and shudder to think what would have become of us without the CAP MR/DD (now I/DD) supports and services I received for my child.

I can only imagine I would have had no choice but to institutionalize my baby girl in such a facility as O’Berry Center, where I once worked while a student at Mount Olive College.

While I no longer carry this burden and responsibility alone, it’s still not an easy life. Isabel is entering adolescence, her challenging behaviors and frustrations are increasing. She is unable to communicate beyond her basic wants and needs (hungry, thirsty, sleepy, dirty…) and now, raging hormones and most recently, a diagnosis of Type 1 juvenile diabetes requiring a hospitalization last month. Every room of our home is adorned with child locks and safety gates and because she is compelled to be in constant motion, she never sits still, never rests, and neither does anyone else. Because we have no outside family support, it is a rare opportunity that my husband and I can even get away for dinner alone or a movie; in the 6 years we have been married, we have gone away twice for short weekends, one of those being a CLE he attended for work. Our life is unimaginable to outsiders, yet we are not alone in our isolation.

There are many other single parents of special children out there dependant upon the “proper supports” and services of CAP I/DD for survival. Perhaps you know that parents of minor children with disabilities cannot receive monetary supports or funding for caring for their child, while parents of disabled adults can; therefore, most have no choice but to work just to exist while strangers care for and raise their angels in their absence.

There are even more special dual-income families who barely makes ends meet; families who will likely be forced to quit a job without “proper supports.” There are countless tired families receiving supports who don’t have the time or the know-how to even begin to speak-up, because they don’t understand the dynamics of this financial agenda, to write a letter such as this one to their representatives pleading for help; families who can’t afford to take even a day off of work to go meet with their senator or congressman and what would they say? Most parents, and even professionals, do not fully understand what little ambiguous information that is out there to even articulate an intelligent argument.

And what of the aging parents with developmentally disabled adult children who have dedicated a lifetime of love, labor, and heartache caring for their child? Like the enormous room full at the Residential Supports Information Session I attended last month, who can no longer physically do it without “proper supports” – the dozens of exhausted elderly citizens whose hopes of relief I watched shatter as they were told there just aren’t enough options, not enough group homes, not enough residential programs, not enough room, not enough funding, and with the new Medicaid Waiver looming around the corner, threats of closure to existing group homes is becoming an increasing reality and the future holds even less answers.

The North Carolina CAP I/DD (formerly, MR/DD) Waiver program, promulgated pursuant to Section 1915(b) and (c) of the United States Social Security Act [42 U.S.C. § 1396o], and was authorized in 1981, acknowledging the greater need of supports for Developmentally Disabled citizens and thus providing a means for states to manage the costs of those needs with federal funding. Section 1915(b) Managed Care and 1915(c) Home and Community-Based Supports Medicaid Waiver programs afford states the opportunity meet the medical and direct care needs of its DD population and afford parents an alternative to institutionalizing their loved ones in an effort to save tax dollars and comply with the Rehabilitation Act of 1973 [5 U.S.C. § 790] and later, Americans with Disabilities Act (ADA) [42 U.S.C. § 12101 et seq.]. When one considers that the annual cost of institutionalization is, in some cases, estimated at over one hundred and twenty thousand dollars ($120,000.00) per resident, forcing families to ultimately surrender their loved ones is hardly the answer to resolving the state’s budget crisis long term.

“Proper supports” for a developmentally disabled CAP recipient is determined by the Support Needs Assessment Profile (NC-SNAP), a scale developed by a team of experts in the field of developmental disabilities over the course of 2 ½ years from 1997-1999. The SNAP tool is reassessed annually to determine an individual’s level of need for Daily Living, Health Care, and Behavior Supports. In some counties, the Supports Intensity Scale (SIS) is also used, which provides a more accurate overall reflection of an individual though is not required and therefore is seldom used. SNAP, while arguably flawed and limited in the client profile it presents, is the only consistently utilized tool for determining service needs. From the SNAP score, a recipient’s eligibility for number of service hours is determined. A “Person-Centered Profile” then outlines the individual’s life-skill and community goals a Habilitative Technician (CAP Worker) works on with their client based upon their level of needed care and allotted hours, which are reassessed and re-written annually in a Continued Needs Review (CNR).

You may be thinking, ‘but reports show that families receiving CAP supports don’t even utilize all of their approved hours as is’... The answer is so simple it befuddles me.

You see, I’m one of those families who doesn’t use all of the hours our level of need warrants and often haven’t throughout the decade or so that my daughter has received both CAP C and MR/DD. (In fact, my budget is quite low I’m told, based upon Isabel’s level of needs.) Allow me to explain why… In the last 10 years, I can recall no less than 19 CAP Workers / care providers to whom I have entrusted my helpless little girl; I cannot even remember all their names as the turn-over rates for these positions is quite high. (In special parent circles, a CAP Worker who sticks around past one year is Gold.) Consider the emotional and developmental damage that such constant inconsistency creates in the daily life of a child with special needs; learning a new person, loving a new person, and losing that person – over and over again (never mind what it does to the parent). And while there have been some wonderful trustworthy care providers in our life, I wish that were the only issue... During this parade of CAP Workers, practical strangers in my home and personal space, I have experienced: the physical abuse of my child when an employee pinched my 3 ½ year old numerous times leaving dark purple and green bruises on her tiny body, thousands of dollars worth of property stolen from my home, and a week’s worth of groceries devoured that I could not afford to replace; I had an employee who took my daughter on a date with her ex-husband she’d previously had a DVPO against who was unaware she was living with a new guy; I once had two employees who became friends and later found that they spend quite a bit of time hanging out together in bars smoking and drinking with my child in their care; one girl who was fired for drug abuse; and last but not least, yet another who filed a DSS complaint against me for “abuse and neglect” in retaliation for being terminated – an incident that wasted the time and resources of 5 separate agencies, including the Morrisville Police Department, Cedar Fork Elementary School, Wake County Human Services, and the Department of Social Services. And that’s just the stuff I know about; anything else that has happened throughout the years, my daughter is unable to tell me.

During the last Bush Administration, the federal Medicaid reimbursement rate was cut by eight dollars ($8.00) per hour, a significant amount when one considers the cost of overhead and employee salaries. Today, the average CAP Worker makes between nine to twelve dollars ($9.00-12.00) per hour when performing “Home and Community Supports” (HCS) services (this is the minimal time designated for working on pages and pages of specific life-skill goals and continuation of therapies, not unlike an IEP) and minimum wage to eight dollars ($7.15-8.00) per hour for “Personal Care Supports” (PCS) services (the bulk of allotted hours which includes bathing, grooming, toileting, etc.) and “Respite” (time built in for unscheduled relief). Comparatively, a Certified Nurse Aide 1 working in a long-term care environment in Wake County makes roughly $13.03 hourly, while a Wake County Teacher Assistant in Special Education averages $10.27 per hour and a Wake County Public Schools Custodian, $12.80 per hour, not including benefits or shift differential. For the record, the average Garbage Collector in the State of North Carolina is paid an average hourly rate of $11.75. A CAP Worker receives only their hourly wages with no benefits whatsoever when working consistently less than 30 hours weekly, not even mileage reimbursement to offset the cost of driving their clients around in their personal vehicles attending community activities as dictated by their care plan.

Suffice it to say that the vast majority of families not utilizing the maximum amount of service hours allotted are not choosing not to do so because the need is not present. Quite the contrary, there is a critical need that cannot be staffed with competent, quality, reliable, professional care providers dedicated to a profession that includes a daily routine of cleaning feces, urine, and vomit; preparing special foods and feeding; heavy lifting; changing G-tubes and catheters and diapers; administering medications; bathing and dressing; utilizing sign language and specialized communication devices; and completing endless amounts of paperwork tailored to a non-applicable medical model to justify their existence all while being subjected to nerve-racking and often abusive behaviors such as hitting and biting, because frankly, people can make a better salary emptying garbage cans than caring for an innocent human being unable to do for themselves.

There’s your answer, Governor Perdue, and the answer is that we families need more support not less.

NC House Bill 916 promises to reduce state costs by cutting consumer budgets for “Home and Community Supports,” and thus services, across the board with a fixed ceiling, regardless of individual need outlined by NC-SNAP. Granted, while “Personal Care Supports” will allegedly remain individualized, such a drastic change in services will only assure the lack of quality staffing for minimal pay and further reduce the quality of life for disabled recipients desperate to participate in community activities by placing them effectively under house arrest. Further decreasing options for recipients and their families, NC HB 916 intends to limit consumers’ already limited choices by establishing a pre-approved provider network.

Among other proposed changes promising to increase efficiency under HB 916, the NC Department of Health and Human Services previously reported plans to establish a central call center to filter consumer calls, placing yet another barrier between families and service needs; they were careful to note however, that the call center would be staffed by non-professionals who would not be able to answer specific questions, though promising a return call within 48 hours. That is insulting.

And what of the appeals process? Considering that HB 916 essentially grants the State of North Carolina complete and absolute authority over how the 1915(b)(c) Waiver programs will be implemented and governed, structurally as well as financially, with virtually no reliable accountability safeguards, I’m not certain that there’s much of a point to appealing directly to the decision-maker – save documentation for federal law suits.

Already, the effects of this transition and the crippling cuts this new Waiver brings are being felt across the state as Case Managers abandon ship for job security and self-preservation, leaving agency professionals and their hefty case loads of clients and families hanging in the balance of uncertainty. Reimbursement rates have been slashed yet again for durable medical supplies, leaving many medical suppliers with their hands tied, unable to fill their clients’ needs. A perfect example being pull-ups for incontinent recipients; reimbursement rates were cut by $.20 per unit leaving the only option as generic unisex pants which do not work at all for children whose bodies are twisted by Spina bifida or even with my own child who is as skinny as a bean and wets through her clothing often 5-7 times a day due to her diabetic thirst and ill-fitting pull-ups. Like many other parents, I’m willing to pay the difference out of pocket to get what works best for my child and makes our life easier, however Medicaid policies, unlike Medicare, do not allow this.

Like most great ideas, there will always be issues to work through and problems that will inevitably arise, but that’s what makes this nation great – we continue to work though issues and solve problems through a system of democracy moving forward for the betterment of all, not selling-out to the most eager government contract bidders with questionable agendas. Sure, we can’t please all of the people all of the time, but in times of crisis, we stand united. –Governor, when we allow the value of human life to be determined by capital gain, when we sacrifice the well-being of the most innocent among us to compensate our own shortcomings, and when we judge the worth of our most fragile, not by their character nor intention, but rather their abilities – we are in crisis.

Our founding fathers entered into a social covenant promulgating that “…all men are created equal, that they are all endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.” That very premise remains the foundation of our country, our society, our constitution, our rights as citizens under the constitution, and even more recent federal statutes such as the Americans with Disabilities and Olmstead Acts, fought tirelessly for generations to assure the necessary protection, supports and thus equality for those abled-differently.

As Governor, you swore an oath to uphold the Constitution and laws of the United States. As the most influential political authority in the State of North Carolina, you hold executive power to veto any legislation you deem harmful to the citizens of the state. You were elected into the office of Governor by people who trusted you to be the leader and voice we so desperately needed and yet, you Governor Perdue, made a conscious decision not to protect our children by allowing North Carolina House Bill 916 to pass June 13^th, 2011. By signing off on this bill, you chose not to set the example and send the message to the rest of North Carolina, and to the rest of the nation, that North Carolina values ALL of its citizens. You chose not to speak up and tell legislature and the world that these precious children, young and old – the most vulnerable citizens of our population, our most meek and kind and trusting special populations – are not for sale when the very survival and quality of our children’s and families’ lives, are put on the chopping block once again to trim the budgetary fat because they are an easy target, the weakest voice of unconditional love, broken dreams, and battle fatigue.

In my life I have learned beyond a shadow of a doubt that special people were not born into this world to be tested, but rather to serve as litmus for the rest of us.

Perhaps you didn’t realize? Perhaps members of the House of Representatives and Senate were not well informed by those weary citizens, their exhausted constituents, who will be most effected? Granted, it is impossible to put a face on every number when you don’t hear their cries in the form of a great roar, when you don’t know intimately their hardships, nor live the pain of their lives just trying to make it through another day.

I’m writing now to give you that face… Her name is Isabel.

I respectfully implore you, beg of you now as the details of NC House Bill 916’s new 1915(b)(c) Waiver plan continues to be worked through, that you please take just a moment, stop… take a deep breath and imagine, just for a brief instance, that you are not Governor, that you’re not an elected official, not a politician, nor even a party affiliate – it’s not that you don’t care what’s going on in the world around you, but your world demands all of your time and energy... Imagine that you’re just an average North Carolinian living paycheck to paycheck trying to be the absolute best parent you can be providing for a child you never anticipated; a child you would give your life for just to hear them speak the words, “I love you.” You juggle all your time between working to provide for your family, feeling guilty over the lack of “normalcy” and opportunity left over for siblings, researching special education law and medical issues, catching up on missed work, catching up on missed life, networking with other parents searching for answers and sharing resources, physically caring for your special child, and fighting for their rights – against the school, against the county, against a library that discriminated against your child, against the state who threatens their very livelihood and quality of existence… You stopped thinking long ago about providing a better life for him or her than you once had; you only want what’s right and just and to not have to wake every single morning wondering that which haunts you to your core, “What would happen to my child if something happened to me?”... Just for a second, please imagine, please consider, what if this were your child?

I often think of that key-note speaker and her story, and still she is right. We do have such a long way to go as a society… No child should ever be thrown away. Please, please help us now.

Let your last decent act as Governor be one of mercy, compassion, and understanding toward the needs and struggles of special populations and their families by encouraging legislature to REPEAL NC House Bill 916 and return to the drawing board. House Bill 916 is NOT the answer!

I respectfully request a written response detailing your current position and intentions regarding this vital matter. I would also like to be kept abreast of any developments and decisions relating to NC HB 916 and 1915(b)(c) Medicaid Waiver plans and decisions and afforded the opportunity to meet and speak as a recipient representative. Thank you in advance.

Once again, I thank you for your time and attention in reading these words that represent the challenges, frustrations, heartache, and desperation of so many North Carolina families. Despite the great length of this letter, I assure you, the paint has barely touched the canvas. Whatever information you need for further reconsideration on this matter, whatever you’d like to see or hear, from whatever county, demographic, parent, or professional, I can and will find it for you. Please do not hesitate to call upon me for assistance or for further discussion.

Help me help you make this right.

Sincerely,

Crystal J. De la Cruz – Hopper

Mother, Advocate, and Concerned NC Citizen

HOPPER LAW FIRM, PLLC

4700 Six Forks Road, Suite 150

Raleigh, North Carolina 27609-5244

email address

Phone: 919-829-5600

Fax: 919-510-5152

Enclosures:

a.     Photo collage of Isabel and her family

b.     “Counting on Me” article written for FPG Child Development Institute, UNC-CH, project magazine, All Together Now, by Crystal J. De la Cruz (as republished in Educating Exceptional Children by Kirk, Gallagher, Coleman, Anastasiow), 11/2003

c.     NC-Support Needs Assessment Profile (SNAP) for Isabel, 02/2012

d.    NC DHHS MR/DD/SAS Person-Centered Profile and Continued Needs Review (CNR) plan for Isabel, 02/2011

e.     NC DHHS MR/DD/SAS CAP / CNR and Medicaid Cost Summary for Isabel, 02/2012

f.   NC DHHS MR/DD/SAS Home & Community-Based Supports Habilitative Technician / CAP Worker time sheets for Isabel’s direct care provider, 07 – 08, 2011

g.     School and Home Daily Activity Sheet recording Isabel’s day, 2012

h.    Daily Diabetic Log recording Isabel’s Blood Glucose levels, Carbohydrate Intake, and daily Insulin corrections, 2012

i.      Wake County Public School System (WCPSS) Physician’s Order and Plan of Treatment, School Based Public Health, 01/2012

j.      WCPSS Individual Education Program (IEP) for Isabel, 02/2012:

                                               i.     DEC-5 / Prior Written Notice of Annual Review and Re-evaluation Determination

                                             ii.     IEP Team Meeting Minutes

                                            iii.     WCPSS DEC-4 / IEP

                                            iv.     WCPSS DEC-7 / Consent for Re-evaluation

                                             v.     WCPSS DEC-2 / Consent for Evaluation / Re-evaluation / Prior Notice

                                            vi.     WCPSS Extended School Year (ESY) Eligibility Worksheet 2

k.     WCPSS “Student Dream Sheet” Assessment form

l.      WCPSS “Things I Am Good At Doing” Assessment form

m.   Isabel’s Wake County Public School System (WCPSS) Report Card / NC Extended Content Standards, 2011-2012

CC:      President Barack Obama

First Lady Michelle Obama

Vice-President Joe Biden

Dr. Jill Biden

Secretary Kathleen Sebelius, US Department of Health and Human Services

Deputy Secretary Bill Corr, US Department of Health and Human Services

Commissioner Sharon Lewis, US HHS, Administration on Developmental Disabilities

Deputy Commissioner Jamie Kendall, US HHS, Administration on Developmental Disabilities

Cindy Mann, JD, Deputy Administrator & Director of State Operations, CMS

Connie Martin, CMS, Division of Medicaid & Children’s Health Operations

US Congressman Brad Miller

US Senator Richard Burr

US Senator Kay Hagen

   

Mr. Al Delia, Acting Secretary, North Carolina Department of Health and Human Services

Dr. Jeffrey P. Engel, State Health Director, North Carolina Department of HHS

Mr. Danny Staley, Deputy Director and Chief Operating Officer, NC Division of Public Health

Representative Grier Martin, D (33) Wake

Senator Neal Hunt, R (11) Wake

Representative Alma Adams, D (58) Guilford

Representative Kelly M. Alexander, Jr., D (107) Mecklenburg

Representative Martha B. Alexander, D (106) Mecklenburg

Representative Marilyn Avila, Joint Caucus Leader, R (40) Wake

Representative Larry M. Bell, D (21) Sampson, Wayne

Representative Hugh Blackwell, R (86) Burke

Representative John M. Blust, R (62) Guilford

Representative James L. Boles, Jr., R (52) Moore

Representative Alice L. Bordsen, D (63) Alamance

Representative Glen Bradley, R (49) Franklin, Halifax, Nash

Representative Marcus Brandon, D (60) Guilford

Representative William Brawley, R (103) Mecklenburg

Representative William D. Brisson, D (22) Bladen, Cumberland

Representative Larry R. Brown, R (73) Davidson, Forsyth

Representative Rayne Brown, R (81) Davidson

Representative Harold J. Brubaker, R (78) Randolph

Representative Angela R. Bryant, D (7) Halifax, Nash

Representative Justin P. Burr, R (67) Montgomery, Stanly, Union

Representative Becky Carney, D (102) Mecklenburg

Representative George G. Cleveland, R (14) Onslow

Representative Jeff Collins, R (25) Nash

Representative Bill Cook, R (6) Beaufort, Pitt

Representative Tricia Ann Cotham, D (100) Mecklenburg

Representative James W. Crawford, Jr., (32) Granville, Vance

Representative William A. Current, Sr., R (109) Gaston

Representative N. Leo Daughtry, R (26) Johnston

Representative Jimmy Dixon, R (4) Duplin, Onslow

Representative Jerry C. Dockham, R (80) Davidson

Representative Nelson Dollar, R (36) Wake

Representative Beverly M. Earle, D (101) Mecklenburg

Representative John Faircloth, R (61) Guilford

Representative Bill Faison, D (50) Caswell, Orange

Representative Jean Farmer-Butterfield, D (24) Edgecombe, Wilson

Representative Susan C. Fisher, D (114) Buncombe

Representative Elmer Floyd, D (43) Cumberland

Representative Dale R. Folwell, R (74) Forsyth

Representative Phillip Frye, R (84) Avery, Caldwell, Mitchell, Yancey

Representative Rosa U. Gill, D (33) Wake

Representative Mitch Gillespie, R (85) Burke, McDowell

Representative Rick Glazier, D (45) Cumberland

Representative Ken Goodman, D (66) Montgomery, Richmond

Representative Charles Graham, D (47) Robeson

Representative Joe Hackney, D (54) Chatham, Moore, Orange

Representative Mike Hager, R (112) Cleveland, Rutherford

Representative R. Phillip Haire, D (119) Haywood, Jackson, Macon, Swain

Representative Larry D. Hall, D (29) Durham

Representative Susi H. Hamilton, D (18) New Hanover

Representative Pricey Harrison, D (57) Guilford

Representative Kelly E. Hastings, R (110) Cleveland, Gaston

Representative Dewey L. Hill, D (20) Brunswick, Columbus

Representative Mark K. Hilton, R (96) Catawba

Representative Mark W. Hollo, R (88) Alexander, Catawba

Representative Bryan R. Holloway, R (91) Rockingham, Stokes

Representative D. Craig Horn, R (68) Union

Representative Julia C. Howard, R (79) Davie, Iredell

Representative Pat B. Hurley, R (70) Randolph

Representative Frank Iler, R (17) Brunswick

Representative Dan W. Ingle, R  (64) Alamance

Representative Verla Insko, D (56) Orange

Representative Darren G. Jackson, D (39) Wake

Representative Maggie Jeffus, D (59) Guilford

Representative Linda P. Johnson, R (83) Cabarrus

Representative Bert Jones, R (65) Rockingham

Representative Jonathan C. Jordan, R (93) Ashe, Watauga

Representative Carolyn H. Justice, R (16) New Hanover, Pender

Representative Patsy Keever, D (115) Buncombe

Representative Ric Killian, R (105) Mecklenburg

Representative James H. Langdon, Jr., R (28) Johnston, Sampson

Representative Stephen A. LaRoque, R (10) Greene, Lenoir, Wayne

Representative David R. Lewis, R (53) Harnett

Representative Marvin W. Lucas, D (42) Cumberland

Representative Paul Luebke, D (30) Durham

Representative Daniel F. McComas, R (19) New Hanover

Representative Darrell G. McCormick, R (92) Iredell, Surry, Yadkin

Representative Pat McElraft, R (13) Carteret, Jones

Representative Wm. C. "Bill" McGee, R (75) Forsyth

Representative Chuck McGrady, R (117) Henderson

Representative Frank McGuirt, D (69) Anson, Union

Representative Marian N. McLawhorn, D (9) Pitt

Representative Henry M. Michaux, Jr., D (31) Durham

Representative Grey Mills, R (95) Iredell

Representative Annie W. Mobley, D (5) Bertie, Gates, Hertford, Perquimans

Representative Tim D. Moffitt, R (116) Buncombe

Representative Rodney W. Moore, D (99) Mecklenburg

Representative Tim Moore, R (111) Cleveland

Representative Tom Murry, R (41) Wake

Representative Bill Owens, D (1) Camden, Currituck, Pasquotank, Tyrrell

Representative Diane Parfitt, D (44) Cumberland

Representative Earline W. Parmon, D (72) Forsyth

Representative Garland E. Pierce, D (48) Hoke, Robeson, Scotland

Representative Larry G. Pittman, R (82) Cabarrus

Representative G. L. Pridgen, R (46) Hoke, Robeson, Scotland

Representative Shirley B. Randleman, R (94) Wilkes

Representative Ray Rapp, D (118) Haywood, Madison, Yancey

Representative Deborah K. Ross, D (38) Wake

Representative Efton M. Sager, R (11) Wayne

Representative Jason Saine, R (97) Lincoln

Representative Ruth Samuelson, R (104) Mecklenburg

Representative Norman W. Sanderson, R (3) Craven, Pamlico

Representative Mitchell S. Setzer, R (89) Catawba, Iredell

Representative Phil R. Shepard, R (15) Onslow

Representative Timothy L. Spear, D (2) Chowan, Dare, Hyde, Washington

Representative Paul Stam, R (37) Wake

Representative Edgar V. Starnes, R (87) Caldwell

Representative Fred F. Steen, II, R (76) Rowan

Representative Sarah Stevens, R (90) Alleghany, Surry

Representative Mike C. Stone, R (51) Harnett, Lee

Representative Thom Tillis, Speaker of the House, R (98) Mecklenburg

Representative Joe P. Tolson, D (23) Edgecombe, Wilson

Representative John A. Torbett, R (108) Gaston

Representative William L. Wainwright,D (12) Craven, Lenoir

Representative Trudi Walend, R (113) Henderson, Polk, Transylvania

Representative Edith D. Warren, D (8) Martin, Pitt

Representative Harry Warren, R (77) Rowan

Representative Jennifer Weiss, D (35) Wake

Representative Roger West, R (120) Cherokee, Clay, Graham, Macon

Representative W. A. (Winkie) Wilkins, D (55) Durham, Person

Representative Larry Womble, D (71) Forsyth

Representative Michael H. Wray, D (27) Northampton, Vance, Warren

Senator Phil Berger, R, President Pro Tempore, North Carolina Senate

Senator Austin M. Allran, R (42) Catawba, Iredell

Senator Tom Apodaca, R (48) Buncombe, Henderson, Polk

Senator Bob Atwater, D (18) Chatham, Durham, Lee

Senator Doug Berger, D (7) Franklin, Granville, Vance, Warren

Senator Phil Berger, R (26) Guilford, Rockingham

Senator Stan Bingham, R (33) Davidson, Guilford

Senator Harris Blake, R (22) Harnett, Moore

Senator Dan Blue, D (14) Wake

Senator Andrew C. Brock, R (34) Davie, Rowan

Senator Harry Brown, R (6) Jones, Onslow

Senator Peter S. Brunstetter, R (31) Forsyth

Senator Chris Carney, R (41) Gaston, Iredell, Lincoln

Senator Debbie A. Clary, R (46) Cleveland, Rutherford

Senator Daniel G. Clodfelter, D (37) Mecklenburg

Senator Warren Daniel, R (44) Burke, Caldwell

Senator Charlie Smith, D (38) Dannelly Mecklenburg

Senator Jim Davis, R (50) Cherokee, Clay, Graham, Haywood, Jackson, Macon, Swain, Transylvania

Senator Don East, R (30) Alleghany, Stokes, Surry, Yadkin

Senator Linda Garrou, D (32) Forsyth

Senator Thom Goolsby, R (9) New Hanover

Senator Malcolm, D (40) Graham Mecklenburg

Senator Rick Gunn, R (24) Alamance, Caswell

Senator Kathy Harrington, R (43) Gaston

Senator Fletcher L. Hartsell, Jr., R (36) Cabarrus, Iredell

Senator Ralph Hise, R (47) Avery, Haywood, Madison, McDowell, Mitchell, Yancey

Senator Brent Jackson, R (10) Duplin, Lenoir, Sampson

Senator Clark Jenkins, D (3) Edgecombe, Martin, Pitt

Senator Ed Jones, D (4) Bertie, Chowan, Gates, Halifax, Hertford, Northampton, Perquimans

Senator Eleanor, D (23) Kinnaird Orange, Person

Senator Eric Mansfield, D (21) Cumberland

Senator Floyd B. McKissick, Jr., D (20) Durham

Senator Wesley Meredith, R (19) Bladen, Cumberland

Senator Martin L. Nesbitt, Jr., D (49) Buncombe

Senator E. S. (Buck) Newton, R (11) Nash, Wilson

Senator Louis Pate, R (5) Greene, Pitt, Wayne

Senator Jean Preston. R (2) Carteret, Craven, Pamlico

Senator William R. Purcell, D (25) Anson, Richmond, Scotland, Stanly

Senator Bill Rabon, R (8) Brunswick, Columbus, Pender

Senator Gladys A. Robinson, D (28) Guilford

Senator David Rouzer, R (12) Johnston, Wayne

Senator Bob Rucho, R (39) Mecklenburg

Senator Dan Soucek, R (45) Alexander, Ashe, Watauga, Wilkes

Senator Josh Stein, D (16) Wake

Senator Richard Stevens, R (17) Wake

Senator Jerry W. Tillman, R (29) Montgomery, Randolph

Senator Tommy Tucker, R (35) Mecklenburg, Union

Senator Don Vaughan, D (27) Guilford

Senator Michael P. Walters, D (13) Hoke, Robeson

Senator Stan White, D (1) Beaufort, Camden, Currituck, Dare, Hyde, Pasquotank, Tyrrell, Washington

Keep your paws crossed!