1. NC Council of Community Programs Presentation to Stakeholder Engagement Group October 26, 2015

2. Non-profit organization, incorporated 1983 to assist area MH/DD/SA authorities to improve their services and management Serves as statewide voice for members through policy and legislative development and analysis, publications, technical assistance, and training and educational activities

3. The NC Council voice is: a consensus position that is built through the NC Council internal vetting process based on “the greater good” so the position may be a win or lose for any individual LME/MCO based on gaps and needs that are trending across the State heard in statewide discussions with a general LME/MCO perspective

4. Alliance Behavioral Healthcare Cardinal Innovations Healthcare Solutions CenterPoint Human Services Eastpointe Partners Behavioral Health Management Sandhills Center for MH, DD, & SA Services Smoky Mountain Center Trillium Health Resources

6. Local Management Entity is the term used in North Carolina statute (General Statute 122C) for the public agency that locally manages State dollars. Managed Care Organization is the national umbrella term used often for Medicaid waiver plan managers that are capitated such as the 1915(b)(c) Medicaid waiver. The terms were fused together to describe the different oversight duties across funding sources. LME/MCOs are public managers and that continues to mean that all savings are reinvested in the community and services.

7. Medicaid (DMA) 1,453,877 94,00 individuals served (monthly average) Uninsured (DMH) 1,437,672 25,00 individuals served (monthly average) Budgets Total State and Medicaid: $3.3b Medicaid: $3b State: $298m

8. Outcomes for an Accountable System and No Waiting List Total State Budget (excluding administration, TBI and DOJ): $298 million SFY2015-2016 Cut: $110.8 million SFY2016-2017 Cut: $152.8 million

9. Spend down on the LME/MCO savings from State-funded services and Medicaid services through a statewide rather than local decision Use savings to fund start-up for Medicaid transformation

10. By the end of SFY16-17, $262 million will have been shifted away from MH/I-DD/SA services. The LME/MCO savings are one-time funds so the State budget will have a $152.8 million dollar hole in SFY2017-2018. Calls to question the General Assembly commitment to the public safety net.

11. Outcomes for Accountable System LME/MCOs continue to manage behavioral health under the 1915(b)(c) waiver for four years after the implementation of a capitated primary health program. Division of Health Benefits (formerly DMA) will continue to negotiate the PMPM directly with the LME/MCOs for the above time period. Capitation payments will be made directly to the LME/MCOs by DHB during this time period.

12. Physical health includes for-profit managers who are not required to reinvest savings in system.

13. Outcomes for Asset Development Allows for the establishment of 529 A private savings accounts to assist individuals with disabilities. Promotes health and independence. Promotes long-term financial planning. ABLE Program Board of Trustees will be established. Became effective when it was signed into law in early August 2015.

14. Outcomes for Inclusive Living and Integrated Employment Budget extends the foster care age to 21. Budget allocates $7.8 million in SFY2015-2016 which increases to $15.6 million in SFY2016-2017 and recurring thereafter for TCLI consumers. Budget specifies $2.9 million in one-time dollars are to be used by the Housing Finance Agency to provide incentives to landlords for offering housing units to persons with disabilities. Autism Health Insurance Coverage will begin in July 2016

15. Outcomes for Waiting Lists and Accountable Systems Budget allocates funding for a TBI Medicaid waiver. Foster Care Act calls for a study of feasibility for a Medicaid waiver focused on children with Serious Emotional Disturbances. Budget expands funds of NC START to cover children and adolescents with I-DD Budget increases funding for I-DD residential, day, supported employment and family support services Cross- Area Services Programs (CASPS).

16. NC Council Soundbite on State Funding Cut-- “Any cut to funding for MH/I-DD/SA services is a cut to PEOPLE and not a business.”

17. NC Council would like to partner with stakeholder groups to coordinate messaging on the State Funding Cut.

18. Please plan to attend the largest annual gathering of MH/I-DD/SU stakeholders at the NC Council’s Conference: INNOVATE INTEGRATE MOTIVATE December 2 ND - 4 TH (Pre-conference December 1 st ) Pinehurst Resort For more information, go to www.nc-council.org or call Jean Overstreet at 919-327-1500