In mid-Feburary, the North Carolina Department of Health and Human Services released updated to the Children and Families Specialty Plan Policy, which is scheduled to launch across the state no later than December 2023.
The Children and Families Specialty Plan (CFSP) will be a statewide specialty NC Medicaid Managed Care plan intended to provide access to comprehensive physical and behavioral health services while maintaining treatment plans when placements change, however counties across the state are sharing their concerns with state leaders regarding the plan.
Currently, North Carolina Counties are served by Local Management Entity-Managed Care Organizations (LME-MCO) — for Western North Carolina, that is Vaya Health. Vaya Health, previously known as Smoky Mountain Area Mental Health as been serving WNC to address the mental health, behavioral health, substance use, and developmental disability issues that may have contributed to their involvement in child welfare in the first place for nearly 50 years, but under the state’s proposed CFSP, Vaya health would be removed from the equation and instead one system would be used for the entire state foster care system.
Through the state’s newly proposed model, DHHS would contract with a single entity which would then be responsible for serving children and families in the foster care system no matter where they are located in the state. So while Vaya Health is located and established in WNC— the single entity could be located in Raleigh, but still responsible for the care of foster care children in Murphy. DHHS states the focus of the plan will be on the unique needs of each case served by the child welfare system and would emphasize keeping families together. However, leaders in Macon County disagree.
“This statewide plan is being touted as a “silver bullet” to address system issues such as lack of providers to deliver services, equitable access to all services regardless of location, and a way in which to lower costs associated with serving these families,” said Macon County Director of Social Services Patrick Betancourt. “However, I want to offer a counter view to these claims: that is, these concerns and many others are currently being addressed in every county in NC through a partnership between local departments of social services and their respective LME-MCO. Establishing an additional, separate statewide mental and physical health plan to deliver many of the same services already being provided through existing plans will lead to duplication of service (increasing costs overall), confusion for families and professionals alike as to whom to turn to for services, and overall system fragmentation.”
Betancourt joined Vaya Health Regional Community Relations Director Shelly Foreman at the Macon County Board of Commissioners’ April meeting to to discuss the proposed changes and its potential impact for children in Western North Carolina.
Senator Kevin Corbin stated that he has spoken with county leaders throughout Senate District 50 and supports their decision to remain with their currently LME.
“My primary concern is always the counties west of Asheville that I was elected to represent and after speaking at length with many of them, I support their decision to opt out of the state’s proposed plan to transition to a single entity to provide these services for families and children in Western North Carolina,” said Senator Corbin. “I recognize that having a single entity or one organization handling this level of care may be needed in other parts of the state that may not have the established relationship with an LME like WNC has with Vaya Health, however, WNC has a working system in place that is proven, effective, and sustainable.”
Commissioner Ronnie Beale, who chair’s the Vaya Health Board noted that the proposed plan is another “stab at taking away the authority of county boards.”
“Think about it,” Beale said to his fellow commissioners. “If you have a child in the ER in crisis, they are going to give you an 800 number to dial.”
Dave Richard, Deputy Secretary for Medicaid spoke to the North Carolina Joint Legislative Committee last week and stated that while counties would have the option to opt out of the statewide plan and remain with their LME/MCO, committee members were concerned that they were already hearing from county leadership about their plans to opt out before knowing what the final statewide plan would look like.
The Macon County Board of County Commissioners unanimously approved a letter to Secretary Kody H. Kinsley, NC Department of Health and Human Services opposing the plan and asking for a delay in issuance the CFSP Request.
“Just as one turns to a trusted contractor when building a house, our communities rely on local agencies and organizations to help build well-being,” reads a letter penned by Macon County Commissioner Chair Jim Tate. “In North Carolina, these agencies and organizations make up our state’s public health system. Although under renovation through Medicaid Transformation, our system has a strong foundation with Jaya Health — one built to offer stability and well-being to the children and families it serves. This kind care will continue through regional Behavioral health and I/DD Tailored Plans when they launch in December and building upon those established foundations will provide the time and support needed to succeed for our children.”