Speaker: Corye Dunn, Disability Rights NC
Do you need the Innovation waiver and the Brain Injury Waiver?
Corye Dunn: You do not need both the Innovation Waiver and the Brain Injury waiver. The two have very similar services, and for the most part, people who are eligible for the Brain Injury Waiver will not also be well eligible for the Innovations Waiver. The only exception would be someone who sustained a head injury after the age of 22, but who already had a pre existing developmental disability that would have made them eligible for the Innovations Waiver.
Is it illegal for a state to have a Medicaid waiver waitlist?
Corye Dunn: It is not unfortunately illegal for a state to have a Medicaid waiver waitlist. In fact, the whole notion of a waiver is that it allows states to waive certain requirements that would usually be applied to Medicaid services and have programs that disregard those particular requirements in this case, uh generally, Medicaid services on the Medicaid state plan have to be available to all enrollees if that if they are medically necessary. And the Innovations Waiver allows the state to offer services to some people, but not all people. And so while there may be requirements elsewhere in law, like the Olmstead mandate under the Americans with Disabilities Act, that requires states to take some action, it's not a violation of Medicaid law to have a waiver waitlist.
Does NC have a plan for DSP providers when Appendix K expires?
Corye Dunn: Does North Carolina have a plan for DSP providers when Appendix K. expires? That's a great question. I think there are elements of a plan emerging and there are some um provisions of Appendix K. That we expect to be adopted more permanently into our Medicaid policies. I think there are still a lot of unknowns about what's going to happen with employees and provider agencies that provide Direct Support Professionals, and have been operating under Appendix K rules for the duration of the pandemic.
It appears to me that most of the providers here in NC have a more willingness to provide congregate care vs inclusive community living.
Corye Dunn: Are providers in North Carolina are more willing to provide congregate care versus inclusive community living? I don't know that that's true as a matter of principle, but we have structured our payment systems so that it is much more sustainable on the provider side to provide congregate services than to provide more individualized, community based services. And we can change those policies to better facilitate community based care and individualized plans and to minimize the state's reliance on congregate care. I don't think it's a matter of whether North Carolina has a different kind or range of providers than other states do so much as that. We have created rules in our state that make it much more likely that someone who wants to provide services to people with I/DD will choose a congregate format because it is um better supported in our funding streams and our policies.
Is there anything in the pipeline to help with adding transportation services to areas not in the normal service areas?
Corye Dunn: We get a lot of questions about transportation and while that's a little bit outside the scope of the original presentation, I think it's worth talking about the role of transportation in access to our communities and to health care and to all the other supports that folks need to live enviable lives in the community. Transportation in North Carolina is limited. We certainly see very different transportation shortcomings in urban versus rural areas and well this question doesn't specify it, it may be that um that they are referring to specifically communities that do not have fixed route transit options where a community already has a fixed route transit option. So that would be something like a bus line or a light rail or something like that. They have to also provide equivalent services through a para transit system to people for whom that system is not sufficiently accessible now. That can look very different from one community to the other. But what every community has is something called non emergency medical transportation. So anything that Medicaid will pay for as a service, you can generally also receive transportation to access that service and that would be arranged through uh depending on your managed care entity, either your standard plan or your M. C. O. Or tailored plan. And if you have any difficulty accessing non emergency medical transportation uh then you can raise that if you're in managed care to the Medicaid ombudsman.
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