Lisa Grafstein for Meet the Need NC

Speaker: Lisa Grafstein, Litigation Counsel, Disability Rights North Carolina

Lisa Grafstein: So the question is how interested are legislators in learning more about the work that you do with disability rights and see and why these issues are important. Um I think there's a lot of interest, there are a lot of folks who really care about the things that we care about, and there there's a lot of information that comes at legislators. So they're very interested in knowing, um not just what results folks with disabilities need, but really some of the ins and outs of how those results need to happen. So there's a lot of interest in in finding out more. There's a lot of genuine concern for issues related to disabilities. There's a lot of um need though coming at legislators. And so what's important is that we all sort of stay active and make sure that if there is an issue that you care about, don't assume that a legislator is aware of it or understand it at the level that you do, it's also really important that people tell their individual stories and that um that your legislator hear from you about your individual story, because it's really hard sometimes to understand information from the perspective of data that people might share, or information from advocates like disability rights. It's the personal story sometimes that really make a difference

Lisa Grafstein: So the question is can you explain why we have so few providers committed to community living? Um And I guess I'm gonna interpret the question one particular way, so I don't know that it's a question of whether providers are not committed to community living, I think the issue is that we don't have enough providers who have the opportunity to provide community based services. In order to build out a provider network, you have to make sure that there are funding sources available that there's support for capacity building amongst providers. So for example, if you have a community based service like supported living or community living and supports, you have to make sure that we're paying enough for those so that providers can hire people and keep them um and and train them and and build build opportunities for them to continue to serve in those roles. So the I don't really really believe that it's a commitment necessary or a lack of commitment by specific providers. I think it's really that we have not enabled enough providers. We also have a system where there's a lot of um bureaucracy, for lack of a better word associated with becoming a provider and it's just much harder for smaller providers, particularly those in rural communities, um those who don't aren't serving a huge number of people to kind of keep up and to be accepted as providers. So we have closed provider networks um in the managed care system for behavioral health. So what a closed network means is that the M. C. O. Gets to control who's a member of the network and um but they also have an obligation to ensure that they have an adequate provider network. So if there are not sufficient providers in the community, it means that something's gone wrong with that with that system. Um And we do see that in lots of different communities across the state. where we have not built that provider network. So I think again the issues come down to making sure the funding is there for people uh that we have adequate rates that there is support given particularly for smaller providers, particularly those who are sort of not a large um large um providers who kind of across the state. And that the M-C-O-s Work toward building out provider networks , particularly by reaching out I think to smaller sort of what we used to call Mom and Pop operators. We've lost a lot of providers of color. We've lost a lot of providers in rural areas because of the inability to maintain those levels of support for them.

Lisa Grafstein: The question is my son has the waiver and he gets all his services through Atrium. They have not signed up for managed care. How will this affect his care? Well that's really concerning and it's going along with a lot of on with a lot of folks across the state. As of this recording, Tailored Plans are set to roll out April 1st (now delayed till October 1). Although there is a question about whether that will happen or not um in large part because there has not been the level of participation by people's primary care and other doctors in the managed care groups that have been set up. So one option is to ask providers to sign up for the managed care networks. That's a hard thing to do, it's a hard thing to navigate if you have providers who are not in the network it might make might be useful to reach out to the M. C. S. Directly and say these are my providers are you working with them and trying to get them into network? Um I will say just to be clear this should not be something that falls on families to have to do but you know where we are right now is that we have a real gap between what what's needed in the provider network uh and and the actual participation level. So it's concerning because there will be a my understanding is I believe it's either 90 or 100 and 80 day period where M. C. O. S. Will be accepting providers as in network even if they haven't signed up. But that just moves the cliff back further so it leaves more time for people to get engaged. But it doesn't solve the ultimate problem which is that people will have to be in network for the most part. Um I would caution you know check with your M. C. O. About your specific providers and whether there are opportunities a to bring them into the system or for individual contracts to to ensure kind of a continuity of care because you don't want to be you don't wanna be stuck out of network. And for the most part people don't want to have to switch doctors in order to stay in network and I'm afraid that's where some of these some of these issues are headed. So I wish I had a good answer. That was reassuring. But I would say you have to stay on top of it unfortunately and um and stay informed about where we are and whether uh whether your providers are getting engaged

Lisa Grafstein: So this question is given this Samantha are ruling appeal stay. Is there anything else that can be done regarding the Dhs plan? Let me just start with a couple of definitions. So that Samantha are ruling that provided for additional waiver slots that provided for help with folks to transition from facilities if they choose. Um and provided for some work around the DSP pay issue. Um That ruling has been stayed by the court pending appeals, so the appeal will take about a year or two. Uh And so the question is, is there anything else that can be done regarding the Dhs just plan? I will say, I don't know exactly what plan is being referenced here. Um There's not really a plan in place that addresses the issues that were in the ruling, which is which is why there's a ruling about it because Dhs did not have a plan to eliminate the waiting list and things like that. And the other pieces of the plan, The other pieces of the order. Um so what what what what can be done in the meantime is we can continue and we will and we have continued to advocate for addressing the the registry of unmet need or the waiver waiting list by pursuing additional waivers lots um through the legislative process. So the order called for elimination of the waitlist within 10 years and that involved um reducing the wait list each year by about 16 1700 slots. Um And so we're advocating to have those slots come online regardless. Um and with regard to the DSP pay issue. We're also advocating on pay increases and I cannot emphasize this enough, the requirement that the M-C-Os actually pay higher rate if that's necessary to keep people in their positions. So I want to go back over that piece a little bit because there's a little bit of assumptions built in. So under managed care. the pay that's set for providers and that they therefore can use to pay their staff. The pay that is set is set by the M-C-Os They set the rates for all services really that are applicable. So I cf rates come from um the M-C-Os How much they pay for community living in, supports how much how much is paid for, supported living, all the different waiver services those are paid for. Are those our rates are set by the M-C-Os Because that's kind of what managed care is the M-C-Os Gets a specific pot of money from the state and they take that money and they manage the money and they manage the care of the people in the system. And so they set rates for people and for providers under what we all know is that we don't have enough that the pay is not high enough for providers and that therefore they cannot pass high enough pay onto staff and that's why we're losing people. So it's really incumbent upon the M-C-Os To pay more. And so one of the things we're advocating for is to pay more attention to that fact that if if rates are not high enough to keep staff, that the M-C-Os Should be paying higher rates. In addition, we think there needs to be in our advocating for pay raises through different legislative appropriations, um, and that there be other work done in order to make sure that we are professionalizing the workforce for DSPs so that they have access to um, credentialing and advancement. So all that's to say all those efforts continue to go on what we don't have is the order telling the state that it has to comply with these things. What we have instead are sort of continued advocacy. And what I would ask is that if this is something you care about, that, you continue that advocacy as well. So, D-R-N-C will be continuing to advocate with the department and at the legislative level asking you to do the same thing. And at the presentation that was part of the presentation included information about how to do those things. So I encourage you to reach out and stay engaged

Lisa Grafstein: Okay, so this question is, will House Bill 76 adequately address the staffing crisis? House bill 76 is what people refer to as the Medicaid expansion bill. So it's the bill that would expand Medicaid to populations that don't currently have Medicaid. The short answer is maybe a little bit, it won't address the staffing crisis in the sense that it won't directly relate to things like direct support, professional pay and um and the provider network in the I/DD Context, it will not um you know, directly impact those what it will do if Medicaid expansion is passed because House Bill 76 has passed the House, but there still has to be a Senate version and there has to be uh an agreement between the two bodies about Medicaid expansion and then the governor has to sign it. So we're not quite there yet. But once we do have Medicaid expansion saying when not if when we have Medicaid expansion that will bring a lot more money into the state in in terms of rural uh and urban areas, support for um health care infrastructure across the state. Because you have money coming in from that will pay providers through Medicaid when they have not been able to access those payments for for people in their communities before. So we'll see just more money in the system which could help support greater access to providers statewide. The staffing crisis kind of just two pieces a little bit. One is that we don't pay people enough and we don't it's not really an adequate support for what you know the direct support professionals that's one part the staffing crisis that kind of that waiver level of you know the individual staff. We also have just kind of you know access to lots of different ranges of medical professionals and healthcare professional support. That again will be helped by Medicaid expansion bringing more money into the state to pay and to develop those networks across the state. But that will take time. The other thing that Medicaid expansion will bring is just some additional bonus dollars from from the federal government. What happens with those dollars is really um unclear at this point in terms of where it will be invested or spent. And so it's possible that will be something that could be used. Um But so the short and too late for a short answer. But the short answer is um Medicaid expansion uh may help some around the margins on I/DD Issues in terms of staffing, it's mostly going to be something that simply building more resources into the healthcare system and that should be helpful to everyone