Tillis Requests Special Session To Address PCS/Group Home Crisis

From The Arc of North Carolina

Tillis Requests Special Session To Address PCS/Group Home Crisis

Special Session first step to solve crisis before Holiday break   Speaker of the NC House Thom Tillis has formally requested that Governor Perdue convene a Special Session of the General Assembly in order to address the looming Personal Care Services (PCS) crisis that threatens the housing of thousands of people with disabilities living in group homes. The Arc of North Carolina is thrilled by this development and appreciates the Speaker's leadership on this issue and his continued dedication to North Carolinians with intellectual and developmental disabilities. The Arc will continue to keep you updated on the PCS/Group Home Crisis as it develops. Please check www.ArcNC.org for information as it happens. The Arc's advocacy staff is evaluating it's next steps in terms of advocacy. Look for an action alert next week. The letter from the Speaker's office is below. See a copy of the original here. --- Governor Perdue, As you know, the General Assembly appropriated $39.7 million in this year's budget to provide for temporary, short-term assistance to residents who would no longer be eligible to receive Medicaid State Plan Personal Care Services under the new eligibility criteria, effective January 1, 2013. The budget provision was drafted as a short-term measure to ensure the funds went to those affected residents who would be potentially discharged from their facility, but would not immediately have a safe community placement. This budget provision was intended to prevent the Department of Health & Human Services from using funds for administrative expenses, appeals, rent deposits, or other items, as requested by the Department during budget negotiations. The Blue Ribbon Commission was summarily tasked with developing long-term solutions to ensure Medicaid beneficiaries receive the services they need. The General Assembly has been working diligently over the last several weeks and months to determine solutions that would prevent the potential unintended closure of mental health and IDD group homes at the conclusion of this calendar year. It is now incumbent upon all of us to do what is necessary to solve this problem. In order to ensure that our state's most vulnerable citizens are protected and allowed to remain in their homes, it is my opinion that legislative action by the General Assembly is needed. Therefore, I respectfully request that you convene a Special Session of the General Assembly under the authority granted to you by Article Ill, Section 5(7) of the North Carolina Constitution. The North Carolina House of Representatives stands ready to take immediate action to resolve this impending problem. If you should decide to convene a Special Session, you have my word that no additional matters will be taken up by the House of Representatives. We will act quickly and decisively to protect the residents of mental health and IDD group homes, and the session will end when that action is concluded. I look forward to your prompt reply. Thank you for your time and attention concerning this very important matter. Sincerely, Thom Tillis   cc: Senator Phil Berger

Medicaid Block Grant & Impact on IDD Populations

From The Arc of the United States

Medicaid Block Grant Information

How will Medicaid Block Grants Impact People with Intellectual and Developmental Disabilities and their Families?

[ original post on thearc.org ] 

Introduction

The House Budget Resolution for FY 2013 calls for drastic cuts to Medicaid ($810 billion over 10 years) that would fundamentally reshape the program—making it less reliable for the people who depend on it and shifting costs to consumers and to the states.

For millions of people living in poverty, Medicaid is a safety net. For many of the 7 million people with intellectual and developmental disabilities (I/DD), Medicaid is a life line. People with I/DD typically require more complex and costly services than Medicaid recipients without disabilities. Frequently, they need care from several different types of health care providers and they often need the services throughout their lifetimes.

What is a Medicaid “block grant?”

A Medicaid block grant would be a fixed amount of money from the federal government to the states to spend on health care for people who are poor, elderly, or have disabilities with only general rules and very little oversight about the way it is spent.

Based on previous federal block grants and the general statements that House Budget Committee Chairman Paul Ryan has made about the FY 2013 House Budget Resolution, we expect that a Medicaid block grant would:

• cap the amount the federal government spends on Medicaid.
• NOT increase this amount to keep up with health care inflation.
• radically cut the federal share of Medicaid.

Why do some Members of Congress want to block grant Medicaid?

All health care spending is growing. Experts claim that it will continue to grow and become an ever larger share of our federal budget. Most Members of Congress are looking for ways to get our fiscal house in order. Some Members of Congress are focusing on the growth of federal spending in the Medicaid program. They believe that block granting Medicaid will save federal dollars. Under a block grant, federal funding for Medicaid would not grow when more people need health services. The challenge of providing health care without any additional federal money to people who are poor, elderly or have disabilities would fall to the states.

What are the most critical Medicaid services for people with I/DD and how does Medicaid pay for them?

The most critical Medicaid services for people with I/DD are:

• Acute care - including hospital care, physician services, and laboratory and x-ray services. These acute care services are mandatory which means they must be provided to everyone who is eligible. States have the option to offer (and most do) prescription drugs, dental, physical therapy, speech therapy, prosthetic devices and other services.
• Long term services and supports - including help getting dressed, taking medication, preparing meals, managing money, getting in and out of bed.

Medicaid is a shared program between states and the federal government and each pays for part of it. The federal share of Medicaid ranges from 50% to 75% of costs. As the need for Medicaid grows in the states, the federal government spends more.

Is Medicaid an entitlement program?

Yes. This means that if a person meets the eligibility requirements (generally poverty, age and/or disability), he or she is entitled to the services available under the state Medicaid program.

What are people with disabilities currently entitled to in the Medicaid program?

Today, each state’s Medicaid program is required by the federal government to provide a minimum level of coverage for the elderly, people with disabilities, and low-income adults and children in order to receive federal matching payments. Minimum services include seeing a doctor, getting x-rays, going to the hospital, receiving care in a nursing home and vaccines for children. Nursing home care is also an entitlement and Medicaid pays for almost half of the long-term care expenditures in this country. It is the primary payer of long-term services and supports for people with I/DD.

What might states do if Medicaid is block granted?

Block grants could force bad choices and cause substantial conflict as groups with diverse needs compete for scarce dollars. Since the services to people with disabilities and the elderly are significantly more costly than health care coverage for children, states could decide to serve fewer costly adults and people with disabilities and focus scarce health care dollars on less costly children. However there is no certain way to know what states will do. Below are possible choices states might make:

• States may reduce coverage of home and community-based services (HCBS) and supports. Most people who need long term services prefer to receive them at home. Over 650,000 people with I/DD receive long-term services paid for by Medicaid. States could decide to stop providing these services or limit the number of people who could get them. There already are over 300,000 people with I/DD on waiting lists for Medicaid home and community-based services. There are 730,000 people with I/DD living with aging caregivers who are approaching the time when they no longer will be able to care for their adult children with I/DD at home. If states stopped providing long-term services for people with I/DD, the waiting lists would grow and the situation for older caregivers would become more dire.
• States may decide to move people into institutions. Under a block grant, rules for providing quality care could be more flexible and conditions in institutions could return to the way they were in the past. With fewer requirements, it may be cheaper for states to care for people with I/DD in large facilities.
• States may reduce eligibility by making it more difficult to meet financial or other criteria. To be eligible for Medicaid, people have to be poor. States could restrict health care services to only the very, very poor.
• States may increase the cost burden on the individuals or family members. States may decide that families should take care of their family members who are elderly, ill or have disabilities. States might decide that sons and daughters should care for their parents when they become frail or ill without any public dollars. In order to get health care, people might have to pay more out of their own pockets. Since people on Medicaid are poor to start with, requiring them to pay for their medical care or long term services and supports could be an insurmountable barrier.
• States may eliminate or reduce the availability of critical services such as personal care, prescription drugs, rehabilitative services, or home and community based waiver programs. All of these services are “optional” under Medicaid meaning that states may choose to provide them under their Medicaid plans or not. If funds become scarcer, states may decide to stop providing these optional services.
• States may slash the amounts they pay to doctors and other providers. It is already very difficult for people using Medicaid to find doctors and other health care providers. Finding a dentist or a specialist, such as a neurologist, is impossible in some communities. If states cut the amount they pay doctors and other providers, those professionals may quit serving people under Medicaid making the problem even worse.

If people with disabilities lose their entitlement to Medicaid, couldn’t they just purchase private insurance instead?

No. Most people with I/DD cannot get medical insurance through an employer because they do not work full time. In fact only 21% of people with all disabilities are working (March 2011). Others cannot find health insurers who will sell them policies because of their pre-existing conditions. Many people with I/DD cannot afford health insurance. Some people with I/DD find that if insurers will sell them policies it does not cover the services they need or the coverage is exorbitantly expensive.

Why are we concerned that services to people with disabilities might be targeted in the states if Medicaid is turned into a block grant?

People with disabilities and the elderly account for most of the Medicaid spending. While children and parents make up about 75 percent of Medicaid enrollees, they account for less than a third of the spending. In contrast, the elderly and individuals with disabilities make up about 25 percent of enrollees but about two-thirds of spending. Medicaid spending per capita in 2009 was $3,442 for families (parents and children) and more than five times higher for the elderly and people with disabilities at $17,763. The elderly and people with disabilities use health care services more often and use more health services and the elderly and people with disabilities are more likely to use long-term services and supports. We are very concerned that states may slash the supports that help people with I/DD live independent, productive lives.

Are block grants cost effective?

A Medicaid block grant doesn’t control the cost of health care which continues to rise as people get older and use more health care services and as the general cost of all health care increases. They do shift more of the cost to that state and likely the individual. Costs may actually rise significantly because people who lose their health care or can’t afford it will stop seeing their doctors or taking their medication. When that happens it makes existing health conditions worse leading to more doctor or hospital visits and more costs down the road and the individual faces more illness and hardship. If home and community based services are reduced it will likely lead to greater levels of costly and unnecessary institutionalization or homelessness. If people are not provided needed services they may not be able to work, learn or function in the community. This creates lost productivity from the individual and family members if they are called upon to provide care when there are no other options.

What can advocates do?

Advocates must make clear to their Members of Congress that block granting Medicaid is not the answer to our nation’s deficit. Advocates must tell their Members what exactly is at stake. The health of people with I/DD may very well be at stake if it becomes more difficult or costly to access needed health services. What will happen if you or your family member loses services under Medicaid or if you have to pay for long term services and supports? Advocates must let their Members know what the biggest concerns are for individuals and families with I/DD if state Medicaid programs are turned into block grants. With less money, would states make it more difficult to become eligible for Medicaid?

• Would they cut benefits?
• Would they cut current levels of spending?
• Would they decide not to cover currently eligible populations?
• Would the states stop serving certain groups of people?
• Would they stop providing entire categories of services?
• Would people with I/DD be able to obtain health care?
• Would people with I/DD have long term services in community settings or would they be forced into institutions?

We must make our voices heard. We all understand that sacrifices will need to be made to address our nation’s money problems. Advocates need to help Congress understand that solving these problems is going to take a common sense, balanced approach. We cannot solve our problems only by focusing on the poor, the elderly, and people with disabilities.

[1] Center on Budget and Policy Priorities Rhode Island’s Global Waiver not a Model for How States Would fare under a Medicaid Block Grant, March 2011. Rhode Island’s block grant is held up as a model by some supporters of block grants. However, the state’s fixed amount of federal funds was greater than their normal federal share of Medicaid dollars. Rhode Island’s program does not reflect what likely would happen under block grant proposals currently being discussed. There also is disagreement about the state’s claims of savings under its block grant.

From Arc NC: Unintended Budget Cuts Must Be Fixed!

From The Arc of North Carolina

Unintended Budget Cuts Must Be Fixed!

[ view original posting ]

It’s time for the Governor and members of the General Assembly to fix the “unintended” reductions of the Social Services Block Grant (SSBG) for people with disabilities. Both legislators and the Governor’s administration seem to agree that an additional cut of $4.3 million to the community system was unintended. Unintended or not, this cut, on top of the $20 million intended reduction by the General Assembly, is causing serious harm to people with disabilities and their families.

It is hard do imagine that while the state is attempting to negotiate a settlement with the U.S. Department of Justice on ADA issues, we would allow further reductions to the fragile infrastructure of the community system. Services that allow people to live at home or in community residential settings are affected by this cut the most. Letting this “accidental” cut stand will hurt people.

The Arc, in a letter to the Governor, has asked that she take the lead on eliminating this cut. We are sending a similar letter to the House and Senate leadership asking them to join with the Governor to fix this unfortunate mistake. Hopefully, all parties will work together to do so.

Members can help by letting the Governor and General Assembly know that this cut must be restored. Let them know that our fragile community system cannot stand more reductions and that people with disabilities deserve better!

Contact:

• Governor Bev Perdue - governor.office@nc.gov (919) 733-5811
• Speaker Thom Tillis - Thom.Tillis@ncleg.net (919) 733-3451
• President Pro Tem Phil Berger - Phil.Berger@ncleg.net (919) 733-5708

WRAL re NC MH Reform & Parent Info.

WRAL report re Managed Care and IDD, etc. 1 message

---

MaryKShort@aol.com <MaryKShort@aol.com>	Sun, Aug 5, 2012 at 11:15 AM
To: MaryKShort@aol.com
FYI ... very well written and researched article by Mark Binker at WRAL.com.  I can see that there are a lot of good talking points to use when you contact your elected representatives to express your concerns or your experiences.  In the article, a Ms. Laurie Haley is quoted:  Laurie Haley has seen ups and downs as North Carolina has slogged through mental health reform efforts over the past decade. For a three-year period from 2005 through 2008, she said, reform seemed to have worked for her daughter, Alissa. Other times, dealing with local and state mental health bureaucrats was more fraught. That period of time covers the pre-Home Supports service definitions.  I happen to agree totally with her EXCEPT for the fact that it was at the end of 2007 and into early 2008 when the state first tried to implement the 40-hour limit!  I don't know if she was impacted by that at the time or if she even knows it is part of the Innovations waiver.  I have written the reporter to ask. Mary K. Short 828-632-5888 or 704-451-4144 (cell) http://www.wral.com/news/state/nccapitol/story/11384615/

Posted: 7:09 p.m. Friday (August 3, 2012) Updated: 12:11 a.m. yesterday

Patients, advocates wary as NC again reforms mental health system

By MARK BINKER, WRAL.com Multimedia Reporter

Raleigh, N.C. — North Carolina is in the midst of an effort to remake the state's public safety net for those with mental health, substance abuse and developmental disabilities.

Lawmakers, administrators and taxpayers want to see if the change to a "managed care" model can really save millions of dollars and avoid the over-spending debacles that marked the first system remake a decade ago.

At stake is how the North Carolina manages more than $2.4 billion in state and federal mental health dollars that flow through local mental health agencies, and how individuals with mental illness will live their lives every day.

"All I want to do is keep my daughter at home," said Laurie Haley.

For her, reforms success or failure will be measured by how it affects her daughter, Alissa. The 27-year-old woman has severe developmental disabilities and also suffers from seizures. Alissa needs help dressing, eating and taking care of other needs. Those who help her need to be able to administer medicine and prepared to act in case a seizure makes her fall in the shower or comes on her in public.

Haley says that she has, for now, ensured that the transition to managed care won't mean fewer services for her daughter. But she said other families making the switch are still encountering problems.

"What I'm hearing is that they're still trying to reduce services for people," Haley said.

That small-scale skepticism of the new system was amplified this summer when a blistering report said that one of the first local mental health authorities given permission to make the transition was not ready for the switch to managed care.

State and local mental health administrators say that one experience should not color the entire transition effort and that the system is on the road to improvement. Advocates, some who work providing services to clients and even some lawmakers say the process may be moving too fast. They worry that counties such as Wake and Durham, which have just begun the move toward managed care, could encounter the same mistakes and problems seen elsewhere.

...

[ There's much more... Read the Full Story on WRAL.com ]

And while statewide success will be measured in millions of dollars, Haley and others like her will measure it in terms of what it means for their loved ones.

"My daughter is not a disability, she's a human being with a disability," Haley said. "If I have the right to live at home and you have the right to live at home, she should too."

• Reporter: Mark Binker
• Web Editor: Jodi Leese Glusco

----------- more from Mary Short...

EXTRA:  Mercer Report link

http://www.wral.com/asset/news/state/nccapitol/2012/08/02/11386093/WHN_Final_Report.pdf

2ND EXTRA:  Federal Report link and quote from that report

http://www.ncd.gov/publications/2012/CMSFebruary272012/

C. Health, Safety and Quality

Abuse, neglect, exploitation, the use of mechanical and chemical restraints, unexplained injuries and denial of services are far too prevalent in our current long-term system of services. CMS has made significant strides in holding states accountable for addressing health and safety issues in the 1915(c) Medicaid Home and Community Based Waiver program; but requirements governing program design, state monitoring and reporting to CMS have not been mandated for managed care programs approved under Section 1115 demonstration waivers or under the dual eligible pilot demonstrations.

3rd EXTRA:  Other news reports from Raleigh sources regarding other budget cuts and budget overruns

http://www2.journalnow.com/news/2012/jul/19/1/centerpoint-faces-a-17-million-cut-from-the-state-ar-2445575/

http://www.newsobserver.com/2012/07/18/2206751/money-woes-snag-mental-health.html

http://www.newsobserver.com/2012/07/26/2222435/state-audit-says-dhhs-efforts.html

http://www.newsobserver.com/2012/07/26/2222839/nc-auditor-catching-medicaid-cheats.html

http://projects.newsobserver.com/under_the_dome/mental_health_office_needs_lots_of_work_consultant_says#storylink=cpy

Submitted  by lbonner on 2012-07-26 14:37
Under the Dome | mental health | N.C.  Department of Health and
Human Services | Western Highlands  Network

Last week, we wrote about a local mental health office that  covers
western North Carolina counties losing $3 million since switching  to
managed care in January.

A consultant's report issued this week  describes problems at Western
Highlands Network, one of the first local  mental heath offices to
convert to a managed care system.

Among other  things, the report says that the information Western
Highlands leaders  receive about services, use and costs is inadequate,
and that it is not  keeping good track of Medicaid claims.

The report goes on for nine pages.  In short, it says Western Highlands
needs lots of improvements, and the  consultant recommends close
monitoring by the state Department of Health and  Human Services.

Under managed care, the local mental health office gets a  set amount
of money to treat mentally ill patients who rely on Medicaid or  state
funds.

Western Highlands Network became a managed care  organization in
January. By next January, managed care organizations  for
government-paid mental health services will cover the entire  state.

And ... news article re WHN & Mercer Report is in it and easy to read!

http://www.carolinapublicpress.org/10977/asheville-western-highlands-network-fires-ceo-scrambles-to-address-funding-shortfall

Labels are for Jars.

Received a mail recently from a dear ole friend of mine, Joe Genera, and thought it appropriate to share his wisdom regarding labels and the human experience... but first, a bit about Joe:

I first met Joe in biology class as a student at Wake Tech, way back before marriage, before Isabel, in a time when I was "young, wild and free" as they say... As my "right brain" has consistently proven to be far more developed than my left, I quickly aligned myself with a sciency-minded study partner, who happened to be Joe. Not only was he (and remains to be) among the most down-to-earth, likable  fellows I've ever met, he's also wise beyond his years and exceptionally intelligent (which made for an excellent choice in lab partners). We became fast friends, sharing many experiences and countless laughs together. I sometimes camped at his house as he was one of the only people I knew back in the days of floppy drives to own a personal computer; I hammered out many a Criminal Justice term paper in his home office in the wee hours of the morning. And he took me to my first theatrical performance - Cats - and opened my eyes (and soul) to a new way of thinking about the poetry of life...

Joe was a slightly older-than-me single dad back then of a beautiful, young active girl who most days drove a sporty teal-blue convertible Corvette - on other days, he drove a custom van outfitted with a lift.

You see, once upon a time Joe was a young ramble-rouser with an affinity for restoring old hot rods... One day, the unimaginable happened when a car slipped from the garage lift pinning Joe beneath and crushing his spine - forever changing life as he knew it. And yet he finished school, worked, raised a daughter, and is a successful business owner, fierce disability advocate and a soon-to-be published author.

(If you want to know anything else, you'll have to read the book, "Arrested Youth" for it's not my tale to tell.)

These days though, back in Connecticut, it is no surprise that he still uses his powers for good, operating an autobody repair shop and program called Team-MuscleCar, LLC: "'TEACHING TEENS - ONE HOT ROD AT A TIME' tm Mentoring to keep kids in school by having them use their hands and minds, and expanding their life skills."

----------- from Joe...

Crystal - just saw your post about labels - thought this might hit a cord with you. An Op-ED piece I did last month.

"LABELS ARE FOR JARS – NOT PEOPLE." – Joseph P. Genera

In the thirty years since a car slipped off a lift, falling six feet through the air before breaking my back as it crushed my spinal cord, I have gone through many life changes. Some, like adapting to a world from a suddenly shorter stature and navigating a bumpy world via a wheelchair, took some getting used to. Other changes, like how the world saw me, or more pointedly - labeled me as, has been one of the more challenging aspects to get used to.

In the three decades since my world so abruptly changed, I have gone from being a ‘cripple’ to a 'person with a disability', with about ten other labels in between. Not because I myself had made any significant changes, or had some miraculous healing come my way. No, the different labels arose from our American society deciding that one name was better, or more ‘politically-correct’, than another. And as with other minority groups, I was personally never asked myself what I would like to be called.

In my own lifetime, I have seen the currently 'P.C.' African-American named population referred to as colored, black, people of color, evolving to today's accepted 'African-Americans.' But, I don't remember there ever being a vote taken of that population, asking them what they as a people, would prefer.

In the case of the 55 million 'persons with disabilities’ in America, there has never been a caucus of any kind that has asked, "What would you like to be called?"

And yet, in the last thirty years I have been dubbed everything from crippled, infirm, afflicted, handicapped, handi-capable and differently-abled. I have been wheelchair-bound, as if I never leave the chair to bathe, sleep or love. One of my least favorite of all is to be branded as an ’invalid,’ which suggests that portions of society thinks that people such as myself are not considered valid members of our world.

Today, the favored phrase seems to be 'person with a disability.' If there has to be a label, this one is probably the least offensive, in that it at least puts the person before whatever condition or impairment that affects his or her life. While positive in nature, who knows how long this current term will be in favor before our polite world decides that I need to be called yet another unasked-for label. In fact, the ‘new and improved’ title that the national media seems to be trying to adapt today is the instantly dependent sounding label: ‘special needs population.’

No, no, no! People with disabilities do not want to be seen as special – they want to be seen as people, period. And they/we certainly do not want to be perceived as needy. As disability can affect any one of us at any time, with little consideration as to race, sex, religion or socioeconomic status, those who come up with these ‘titles’ should ask themselves – ‘If I were hit by a bus tomorrow and became paralyzed, would I want to be immediately affixed with the label ‘special needs person?’

In this country, much time, thought and energy go into defining what is politically correct, what words are best to use to ensure that the majority of a specific population is not offended, and so that the rest of society feels good for having come up with the next ‘right thing.’ Even within the ranks of the various disability groups, there is constant in-fighting as to what their own monikers should be. Energies and resources are wasted on such pursuits, when the time could be better used to improve the very real physical and psychological barriers that people with disabilities face every day.

No one wants to be offended, and most people with good sense do not want to offend. That’s the reason why everyone from the average person to the national media struggles with the question "What do we call 'those' people?"

I know exactly what I would say if I were ever polled, or had to vote for the very best label for the world to bestow upon me.

Just call me Joe. Thanks.

----------- my reply...

Dearest Joe, as long as I've known you - a lifetime it seems (I bought my first legal 6-pack with you if you recall [and much to my 21-year-old disappointment, was not even carded]), even back in pre-Isabel days when life for me was oh-so-much-easier though exceptionally less profound - I have never, ever thought of you as "disabled"... You??? LOL Not able to do something - outside of say a running long jump (which if this two of us were competing, you'd probably win truth be told) - preposterous! Pfft... And you know I am not saying this out of some misplaced need to defend myself regarding what I assume you to believe I think; I know you know me... My point is, you are among the most able and capable, intelligent and AMAZING human beings I have ever been blessed to know - who has yet once again, smacked my sensibilities upside the aha... reminding me of the absolute profundity of it all: human connection.

It's really all the same isn't it? There is not a one born among without purpose and no purpose is without importance, nor is one purpose greater than another... regardless of perceived 'ability', color spectrum, belief, education nor status. "Normalcy" indeed is a manmade definition to corral ourselves within our comfort zone. --Until we each recognize these truths within ourselves and step outside of our own limitations, we are doomed to remain ourselves "disabled."

I never imagined I would have another child after Isabel. When Liam came along, it was like being a first time parent all over again; a whole different ballgame! --As he grew and began to become aware of his world, talk and ask questions (OMG, does he talk!), he would ask me why sissy didn't speak or why she does things that she does... I tried to explain to him once that Isabel was "special"... I thought that explanation was a pretty good one and seemed to quiet his curiosities (I should have known better). The next days he came to me crying and told me that he wanted to be "special" too. --From the mouths of babes! Oh, talk about breaking your heart! ...So we had a long talk about purpose and God and how Isabel is as God intended for her to be; that while we may never know her intended purpose for this world, the fact that she does not speak verbally and doesn't think the same way we do was part of her purpose and that purpose was very important... That just maybe her purpose was to teach us to be better people and understand how to love everyone the same?

I have always made a conscious effort to never describe someone by their abilities, ethnicity, etc. because I did not want to plant the seed in his thinking that these things were a measure of an individual. --About a year ago, when Liam was four, it came home to me in such a profound way when he came home from preschool telling us about his new friend, "Johnny"... Who is Johnny we asked, trying to put a face with a name? You know, he said, the boy with the super-hero eyes - and then he put his fingers on each temple by his eyes and pulled back the skin to show us... (Johnny's parent's are of asian decent.) To Liam, his new friend was nothing short of a rock star. =)

Joe: In this world, in this life, we tend to get stuck so often in the gravity of ourselves, our own lives, problems, issues and goings on; I am no less guilty. Though I try to make certain that those sacred souls in my life always know how much I love them, that they have mattered to me in magical ways, and I could not have made it this far without them... You are one of those sacred souls - I know I don't say it often enough... so, just to reiterate: Not only have you shaped me in ways you will probably never know in all the years, but I love you dearly.

Thank you for your words dear one...

----------- from Joe...

Absolutely! And please know that was in no way a rebuke of any kind to you ...at all! I just love reading your posts, personal and the NC ones and thought it might fit... And it does, cuz of who you are!

I am so glad you came and asked about my motorcycle 20 years ago. I love you too Crystal

P.S. And of course you can post!

First LME to become MCO Facing Budget Overruns

From The Arc of North Carolina

First LME to become MCO Facing Budget Overruns

[ view original article ]

Western Highlands Network (WHN), the Managed Care Organization (MCO) that provides state funded services to people with intellectual and developmental disabilities (I/DD) in several western counties, recently reported that they are running a monthly defecit of $500,000 since they became a managed care organization in January 2012. WHN officials indicate they feel the State’s original capitation (reimbursemnt) rate was insufficient to cover the Medicaid cost of their program.

When questioned by members of the Disability Waiver Advisory Committee on July 24th, State officials responded that the budget deficit had been uncovered in a routine monitoring visit and that they would be attending the upcoming WHN board meeting. They offered no further explanation.

Apparently the State, along with the Mercer consulting firm, reviewed WHN in mid -July to determine what was causing the cost overruns. At this time, we do not have the results of this review, but we will report as we find more details.

The revelation of these cost overruns is concerning on many levels. Most importantly, we are concerned WHN will be forced to make significant cuts to services in an area that already has significant numbers of people with I/DD waiting for services. To correct this deficit, WHN plans to evaluate rates paid to providers and the amount of service provided to consumers. If this problem results in service reductions, it will be further evidence that Managed Care “savings” are really just another name for “cuts.”

If the capitation rate is too low, as WHN claims, and the state adjust it upwards, it will erode the “savings” North Carolina hopes to gain from the implementation of the Managed Care Waiver. Such a development would call into question why we would make such a massive change for little gain.

Another concern is how the state deems a MCO ready to proceed. According to state officials, all pending MCOs pass rigorous tests to assure that they are ready to go “live” as a managed care entity. The State contracts with Mercer to engage in this process, as do state officials charged with implementing the Waiver. If WHN was really ready to go “live” in January, it is hard to believe they could be losing money at such a pace.

The Arc believes the WHN staff and DHHS staff are sincerely attempting to find solutions to this serious problem. We hope that this issue is only temporary and that services will not be disrupted to the people this complicated system is intended to serve. However, we do believe this issue should prompt the DHHS and the General Assembly to truly examine the model and pace of this implementation. In an at risk Managed Care system, the only people truly at risk are the people it is intended to serve.