An Assessment of the North Carolina Department of Health and Human
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An Assessment of the North Carolina Department of Health and Human Services’ System of Services and Supports for Individuals with Disabilities Submitted to the North Carolina Department of Health and Human Services By the Technical Assistance Collaborative and the Human Services Research Institute Technical Assistance Collaborative 15 Court Square, 11th Floor Boston, MA 02108 April 30, 2021 This page intentionally left blank Table of Contents Executive Summary ................................................................................................................. 7 Chapter 1: Background and Approach ................................................................................... 15 Chapter 2: Summary of Key Findings and Relevant Information ............................................ 21 Chapter 3: Assessment of Findings ........................................................................................ 39 Chapter 4: Recommendations ............................................................................................. 107 Chapter 5: Conclusion and Next Steps ................................................................................. 129 Appendix A: Data Gaps and Limitations ............................................................................... 131 Appendix B: State Agencies and Organizations Interviewed ................................................ 133 Appendix C: Sample Interview Questions ............................................................................ 135 Appendix D: Olmstead Planning Listening Session Dates by Stakeholder Group .................. 137 Appendix E: North Carolina Olmstead Planning Listening Session Poll Questions ................ 139 Appendix F: Olmstead Planning Listening Session Themes by Stakeholder Group ............... 149 Appendix G: Olmstead Planning Listening Session Poll and Survey Results .......................... 169 Appendix H: Key Documents Reviewed ............................................................................... 177 Appendix I: North Carolina Housing Resource Scan ............................................................. 179 Appendix J: Medicaid and DMH/DD/SAS Claims Service Categories .................................... 221 Appendix K: Abbreviations Used in this Report ................................................................... 223 Appendix L: Glossary ........................................................................................................... 225 Tables Table 1. Listening Session Attendees by Stakeholder Group ................................................................ 17 Table 2. Online Survey Respondents by Stakeholder Group ................................................................ 19 Table 3. Medicaid (b)(3) and Non-Waiver State Plan Services ............................................................. 34 Table 4. Medicaid- and State-Funded Enhanced Mental Health and Substance Use Disorder Services ................................................................................................ 40 Table 5. Expenditures on State-Operated Facilities by Type, Fiscal Years 2016 to 2019 ..................... 54 Table 6. Numbers of Persons Served in North Carolina’s State-Operated Facilities ............................ 54 Table 7. Patients Waiting for Admission to State Psychiatric Hospitals in Fiscal Years 2019 and 2020, by LME/MCO ........................................................................................ 56 Table 8. Average Daily Census at Alcohol and Drug Abuse Treatment Centers, 7/1/2020 – 12/31/2020 ..................................................................................................................... 59 Table 9. Persons Served at State-Operated Developmental Centers in Fiscal Year 2020 ................... 60 Table 10. Census at State-Operated Developmental Centers at Beginning of Fiscal Year, 2015–2018 ............................................................................................. 60 Table 11. Developmental Center Patients with a Secondary Diagnosis of Autism Spectrum Disorder ............................................................................................................ 61 Table 12. Expenditures for State-Funded Developmental Disability Services by Type, Fiscal Year 2019 ................................................................................................................... 63 Table 13. Per-Person Expenditures at Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IIDs) ............................................................................ 63 Table 14. Persons with a Mental Health Diagnosis Served in Select Congregate Settings, Fiscal Year 2019 .................................................................................................................................. 64 Table 15. National Core Indicators Survey Respondents Named on a Lease or Deed ........................ 65 Table 16. Individuals served in community-based Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IIDs) in Fiscal Year 2019 ....................................... 66 Table 17. Children with Serious Emotional Disturbance served by a State Mental Health Authority — in North Carolina and Nationally, Fiscal Year 2019 ............ 70 Table 18. Medicaid-Funded Behavioral Health Service Penetration by Diagnosis, Fiscal Year 2019 .................................................................................................................................. 73 Table 19. State-Funded Behavioral Health Service Penetration by Diagnosis, Fiscal Year 2019 ......... 73 Table 20. Medicaid Beneficiaries with a TBI-Related Medical Visit by State Fiscal Year ..................... 76 Table 21. LME/MCO Behavioral Health Services Delivered to Youth and Adults ................................ 82 Table 22. Penetration Rates for Medicaid-Funded Mental Health Services by LME/MCO, Fiscal Year 2019 .......................................................................................................... 82 Table 23. Penetration Rates for DMH/DD/SAS-Funded Mental Health Services by LME/MCO, Fiscal Year 2019 .......................................................................................................... 83 Table 24. Rate of Persons Served in State Psychiatric Hospitals per 100,000 Population by LME/MCO in Fiscal Year 2020 ....................................................................................................... 84 Table 26. Penetration Rates for MH/DD/SAS-funded SUD services by LME/MCOs, Fiscal Year 2019 .................................................................................................................................. 85 Table 27. Penetration of Innovations Waiver Services among Waiver Participants by LME/MCO, Fiscal Year 2019 .......................................................................................................... 86 Table 28. Penetration Rates of State-Funded Developmental Disability Services by LME/MCO, Fiscal Year 2019 .......................................................................................................... 87 Table 29. Use of Self-Directed Services Option in North Carolina and Nationally ............................... 92 Table 30. Gender and Race/Ethnicity of Individuals Receiving Behavioral Health Services, Fiscal Year 2019 .................................................................... 93 Table 31. Gender and Race/Ethnicity of Individuals Served by Waivers or on Waitlists, Fiscal Year 2019 .................................................................................................................................. 94 Table 32. Individuals on Innovations Waiver Waitlist on the First of the Month, December 2019 .................................................................................................................................. 98 Table 33. Medicaid Expenditures for Mental Health Services by Service Type, Fiscal Year 2019 ..... 104 Table D-1. Listening Session Dates by Stakeholder Group .................................................................. 137 Table I-1. PHAs in North Carolina with NED or Mainstream 5-Year Vouchers ................................... 181 Table I-2. Housing Choice Voucher Utilization Rates (Tenant Based Vouchers Only) by Nonelderly Disabled and Elderly Disabled Individuals ............................................................... 183 Table I-3. PHAs in North Carolina with Public Housing Units .............................................................. 186 Table I-4. Public Housing Utilization Rates by Nonelderly Disabled and Elderly Disabled ................. 190 Table I-5. FY 2020 Consolidated Plan Administer Agencies for State of North Carolina ................... 194 Table I-6. FY 2020 CPD Funded Communities ..................................................................................... 194 Table I-7. Consolidated Plan Highlights ................................................................................................ 200 Table I-8. Permanent Housing in North Carolina CoCs (HIC, 2019) .................................................... 206 Table I-9. National Housing Trust Fund Awards to North Carolina..................................................... 207 Table I-10. Active Tenancies in Transitions to Community Living Initiative ....................................... 210 Table I-11. Targeting Program by Subsidy Source ..............................................................................