The North Carolina Social Services Consortium: Legislative Report March 20, 2015

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1 The North Carolina Social Services Consortium: Legislative Report March 20, 2015 Coalition Meets with Barringer Representative from the County Directors of Social Services, NC Child, NC Child Care Coalition, Smart Start and the NC Partnership for Children met with Senator Barringer on March 18 as a follow-up to a separate meeting held with Representative Burr regarding revising the child care policy provisions enacted in last year s budget. Senator Barringer seemed supportive of all the goals outlined by the coalition (see below), however, expressed concern regarding funding ability and encouraged the group to prioritize the list of legislative goals. Senator Barringer also recommended following up with Senator Hise regarding the requested policy changes. The Policy Group intends on meeting with Senator Hise next week to discuss the proposal and gauge the Senator s support. Similar to the meeting with Representative Burr, the specific issues and goals addressed during the Barringer meeting are as follows: Family Income Unit: Exclude the income of a nonparent relative caretaker from the definition of family income unit so that grandparents (and other extended family members) can continue to care for the children. Income Eligibility: Establish universal income eligibility at 200% of Federal Poverty Level (FPL) for all children ages Prorating of Parent Co-Pay: To establish a consistent method of implementing parent copay fees for child care subsidies that recognizes and supports the child s plan of care and parent s work schedule, which may include the need for part-time care. PED Amends Work Plan to Study County Social Service Departments The Joint Legislative Program Evaluation Oversight Committee approved a motion to amend the Program Evaluation Division s (PED) work plan to authorize an evaluation of county departments of social services administration of the North Carolina Medicaid Program. Committee Co-Chairman Rep. Craig Horn, R-Union, prompted the request, as part of legislation (Senate Bill 114) requiring a person who has primary custody of a child receiving subsidy payments to cooperate with county child support services programs as a condition of receiving child care subsidy payments. The PED study will examine how counties administer Medicaid eligibility. The Program Evaluation Division will study a random, representative sample of the state s 100 county social services agencies based on population size and rural vs. urban. We will let you know if there are efficiency problems, said PED Director John Turncotte. If so, we will let you know the scale. If counties are efficient, we will let you know how efficient they are. In addition, Turncotte said, the PED team will review variations in procedures and processes, benchmarks, as well as best practices in North Carolina and other states. PED staff will then present findings and make recommendations for administration and legislative action. A preliminary report will be submitted to the Joint Legislative Program Evaluation Oversight Committee in June and a comprehensive report will be submitted to the Joint Oversight Committee on Health and Human Services and the Fiscal Research Division in January ST. MARY S ST., SUITE 140, RALEIGH, NC POLICYGROUP.NET

2 Legislative Q & A Sens. Jeff Tarte and Stan Bingham, Mecklenburg and Iredell county Republicans, respectively, asked about the scope of the study and how the Program Evaluation Division team would address severe discrepancies among county social services departments in determining Medicaid enrollment. "We will look at any feature, workaround or however it s termed on the county level, said PED Director John Turncotte. A couple of years ago, there was a tremendous surge in Medicaid eligibility due to a change in technology and the counties couldn t handle it. We were on the verge of losing our certification in the food stamp program. Turcotte also said he anticipated the Program Evaluation Division would be tasked with a major study during the legislative session. Consequently, he assigned a team, including Carol Shaw, Dr. Pam Taylor, Dr. Brent Lucas and Jim Horn, to conduct the study. It turns out our contingency plan is working, Turncotte said. We can handle it. In the event of significant discrepancies among county social services agencies in determining Medicaid eligiblity, Turncotte said the Program Evaluation Division would consult with agencies and stakeholders, including county social services departments, to determine what conditions and circumstances led to the discrepancies and any ideas stakeholders have in resolving them. PED staff would include stakeholder ideas, as well as review clearinghouses and best practices, in making final recommendations to the Joint Legislative Program Evaluation Oversight Committee to consider. Rep. Jean Farmer-Butterfield, D-Wilson, asked whether the PED findings would affect Medicaid reform. Turncotte said the PED study would not affect whether the state s Medicaid program would continue a provider-based, fee-for-service model or evolve into something else. Turncotte said some importance of the study would be placed on the variations in policies and procedures in making Medicaid eligibility decisions among counties. We will be looking at best practices and bright line standards, Turncotte said. At this point, I don t know what we re going to find. He also commented that other states have a unified system of state policy implemented in counties. In these states, county social services employees were considered state employees and presumably worked under the same policies and procedures to determine eligibility and administer benefits. Rep. Nelson Dollar, R-Wake, and the House s Medicaid policy expert, also responded to FarmerButterfield and said the state shifted the classification of county social services employees from state to local employees to reduce the state s financial burden. Dollar also said county social services agencies were expected to have the Medicaid eligibility backlog completed by the end of June. Efforts Continue to Remove Audit Language from S14 In light of the Program of Evaluation amending their work plan to include a study of county departments of social services administration of the North Carolina Medicaid Program, the Policy Group has been working with members of the conference committee for Senate Bill 14 in effort to remove language calling for an audit of County DSS Agencies. Senate Bill 14 was amended in the house to include several provisions that resulted in the bill receiving a non-concurrence vote when it came back to the Senate. It is the position of the NCACDSS that there is no need for the audit language to be included in addition to the PED study as it will be overly burdensome on the County Directors and will be duplicative in evaluation. The Policy Group has received assurances from conference committee members that the audit language will be removed but the process is continued to be monitored daily with the expectation of seeing a final bill produced in the coming week.

3 S114 Gets Hearing in Senate Health, Moves Quickly out of Judiciary Committee, to the Senate Floor and on the House The Senate Health Care considered Senate Bill 114, which requires the State Department of Health and Human Services, Division of Child Development and Early Education and the Division of Social Services, to develop a plan requiring persons with primary custody of a child who receive child care subsidy payments to cooperate with county child support services programs as a condition of receiving child care subsidy payments. The legislation came as part of a recommendation and report from the Legislative Program Evaluation Division during the 2014 interim. Under the current system, only cases that come through the Work First program are automatically referred to child support enforcement. The proposed legislation would require cases coming through both the Work First and child care subsidy programs to be referred to child support enforcement as a means of obligating the absent parent to pay child support, explained Sen. Shirley Randleman, R-Wilkes, the bill s sponsor. Sen. Floyd McKissick, D-Durham, commented that the legislation seemed like a good, common sense bill and asked whether there was opposition to it. Sen. Randleman said all of the stakeholders, including the Social Services Association, worked on the bill. We think it s a good way to obligate the absent parent, Randleman said. Sen. McKissick moved to give the bill a favorable report. The committee unanimously agreed. The bill is now referred to the Senate Judiciary I Committee. Senate Bill 114 The bill requires divisions within the Department of Health and Human Services to develop a plan requiring an individual with primary custody receiving child care subsidy payments to cooperate with county child support services programs as a condition of receiving child care subsidy payments. In developing the plan, the DCDEE and DSS shall, at a minimum, consider each of the following: (1) The number of child care subsidy cases that would be referred to county child support services programs. (2) Whether there are any disparities between child support services programs administered directly by the county department of social services versus those programs administered by a vendor through a contract with the county department of social services, specifically as related to maintaining consistent communication. (3) The access and exchange of information between county child support services programs/systems and child care subsidy services/systems and any differences that may create a conflict in coordinating child care subsidy payments with child support services. (4) Any implementation issues related to IV-D child support cases versus non-iv-d child support cases.

4 (5) Any impact on the families involved and the need to incorporate good cause exceptions for cooperation with county child support services programs similar to those for Temporary Assistance for Needy Families (TANF) and Medicaid. (6) Any costs to implement the plan, including any automation costs associated with connecting the child care subsidy payments system to the child support payments system. (7) The development of any forms needed to implement the plan. (8) Transition time needed to implement the plan and to coordinate any interface with current systems, such as the North Carolina Automated Collection and Tracking System (NC ACTS) and North Carolina Families Accessing Services through Technology (NC FAST). (9) Any training needs and costs with training. (10) Other states that have implemented a similar plan as proposed in this section. (11) Other programs of public assistance in this State requiring coordination with 14 child support services programs. (12) The need to update any current policies or procedures related to child care 16 subsidy payments and child support payments. (13) Any other issues DCDEE or DSS deem relevant. The Division of Child Development and Early Education and the Division of Social Services must submit a report on the plan, along with any recommendations, to the Joint Legislative Oversight Committee on Health and Human Services and the Fiscal Research Division no later than February 1, After quickly moving through Judiciary Committee with no amendments, S14 went to the Senate floor, receiving a 48-0 vote on 3 rd reading. The bill is expected to be read into the House and assigned to committee next week. Relevant Link Senate Bill NCACDSS Works to Tweak H146 on the Senate Side Having heard from Directors in various counties regarding their concerns over H146: Amend Advance Health Care Directives Laws, the Policy Group is working with the NCACDSS to create amendment language to add to the legislation once it moves to the Senate. The legislation is scheduled to be heard in the House on Monday, March 30. Once the legislation is assigned in the Senate, with the sponsor s approval, the Policy Group will seek to offer amending language to address the outstanding concerns of the Association. Joint Oversight Committee Considers Partnership with Pew Charitable Trust The Joint Appropriations Committee on Health and Human Services considered a proposal to partner with Pew Charitable Trust and the MacArthur Foundation (Pew-MacArthur) to evaluate the efficiency and effectiveness of state health and human services programs.

5 Everybody wants to make strategic choices, recognizing that you have limited funds given to you through taxpayer dollars, said Gary VanLandingham, director of the Pew-MacArthur program. Budget documents don t tell you what programs are out there or how well those programs are doing. This provides a private sector analysis of our investment choices and whether they are the best buys. Should North Carolina participate, the initial study could focus on programs that serve low-income, pregnant women and children from birth to age five. Legislative response to the proposal was mixed and divided among party lines. Republicans said they welcomed the opportunity to enumerate the state s health and human services programs, quantify exactly how much the state spends on each program, and evaluate the program s effectiveness determined through national, research-based outcomes. Democratic committee members expressed reluctance to change the current model, contending that North Carolina already has evidence-based programs. They also questioned the scope of the study and whether national models could work in North Carolina. No legislative action was taken.