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House | January 31, 2013 | Committee Room | Appropriations

Full MP3 Audio File

Before we move into the consideration of the one bill, on our calendar today, let me just stop right here and ask if you have any questions that I can answer in terms of the procedure? If not, I'm going to turn the Chair of the meeting over to Chairman Johnson. [SPEAKER CHANGES] Good Morning. Since we will have questions after this, if freshmen could keep their nameplates out, we've got so many, want to make sure we call the right name. We don't have to have a motion to have this bill before us, it's a first edition, and Representative Dollar's going to present House Bill 5. [SPEAKER CHANGES] Thank you, Madame Chair. The committee you have before you is House Bill 5, and I'll try to give you the simple explanation of the house bill. What you have in front of you I believe you've probably got the physical note, there's no physical impact to the bill since it accesses currently available funds and does not exceed those funds. There is a brief bill explanation. What this bill does, very simply, there's technical language in there but what this bill does is a very simple thing. What this bill does is it allows individuals in group homes who have lost...who are no longer qualified for personal care services as of January 1, 2013, or for those who are appealing that assessment, once that appeal is completed, if prior to June 30 of 2013 would be able to access temporary funds for their financing of them in that facility. This is currently available to individuals who are in adult care homes, it was never the intent, in my opinion, of the General Assembly to leave out group homes because the individuals impacted who are in a facility whether it's an adult care home, or whether they were in a group home, and the group homes are smaller facilities, it's usually two to six individuals, it was never the General Assembly's intent to leave out group homes to start with, because the individuals involved have exactly the same circumstance. And, in many cases, are essentially exactly the same people. But, the department in their interpretation of an amendment that was put in on technical corrections bill last year said that they were left out. We went through several rounds of this with the Legislative Oversight Committee in the Fall and for the purposes of making sure that we move on and are clear as a General Assembly, we are putting this bill forward. I'd be happy to give you a longer explanation of what's going on with personal care services and the like and the federal involvement if someone desires that, or you can let me do that on the floor, I'll certainly be free...ask any questions you wish but I think that essentially covers it for this legislation in terms of what it does. [SPEAKER CHANGES] Representative Horn. [SPEAKER CHANGES] Thank you, Madame Chair. First, I'd like to make the motion to get the bill before us. I guess we needed to do that...is that right? You'd mentioned that in the beginning? [SPEAKER CHANGES] No, it's a first edition, we don't have to have a motion, but thank you. [SPEAKER CHANGES] My question, then, is, could you very briefly describe for us what personal care service means. [SPEAKER CHANGES] Yes, sir. Personal care services is an optional Medicaid service that the State of North Carolina provides in its Medicaid program, and the issue originally came up, I'm not sure when the State originally started with offering personal care services in Medicaid, but I do know in the 90s what happened is, you have the program set up as a bifurcated program. And, you had one definition of personal care services for in-home, individuals staying in their home, and a separate definition for personal care services for those who are in a facility, whether it be an adult care home, group home, nursing home, whatever...

general intent of the General Assembly. When this was designed, the General Assembly’s intent was for individuals similarly impacted by the changing definition of personal care services to be able to access this pot of money. Just as you would if you were in an adult care home. There’s more than sufficient funds in there and it will operate the mechanics of it and the qualifying of it will be the same as it’s already in session law with the budget that we passed last year. [SPEAKER CHANGES] Representative Michaux. [SPEAKER CHANGES] Yes, ma’am. Follow up. Representative Dollar, I’m still trying to figure out...we had already appropriated $39.7 million for community living funds. From what I understand, those are the funds that are authorized by the budget for that particular program, this program was not included in that. I guess my question is, did you over budget for the program that the funds are coming out of, or if you didn’t, then if that fund runs short before July 1, how are you going to make up that money? [SPEAKER CHANGES] Well, if you look at the legislation on the second page, these funds, and let me go ahead and mention something here, these are temporary funds, this is a temporary fix that does not go pasty June 30 of 2013. Payments would end effective June 30th of 2013 if you look on page 2 line 8, or upon depletion of the $39.7 million appropriated. When the funds are finished, now what is happening in practice, when we set that number at $39.7, we were making the calculation including individuals that would be impacted in group homes. That was within the original thinking so that was from the General Assembly’s perspective, we had already taken that into account. Whether an individual was in an adult care home or whether they were in a group home or there are a couple other setting that this would have an impact on so we believe that there will be sufficient money there to cover those additional individuals. What has also happened is that with the number of appeals, they're probably going to be excess money left over. We do not anticipate this fund being depleted. [SPEAKER CHANGES] Representative Saine, you have one more follow up… [SPEAKER CHANGES] You know, Madam Chair, I’m just as old… [SPEAKER CHANGES] I realize you know the procedure. [SPEAKER CHANGES] As an old appropriations chair. My problem, Representative Dollar is very simply this. The money was appropriated at $39.7 million was appropriated for one program. The other program which may have been included in there, but was not, is now being put back in. The problem I’m having with this is you mentioned the appeals. You know that the appeals process is slow, but if the appeals process starts speeding up then you’re going to have a problem. If this money runs out before June 30, where are the other funds coming, number one where are the other funds coming from in order to take care of this program, and number two, I still don’t understand how you take this 39.7 for one program and apply it to a second program and think your going to run both programs off that 39.7. [SPEAKER CHANGES] Well, maybe I’ll try to clarify it this way. It’s not two separate programs. It’s one program. But what the department came back and they took a particular group of individuals and they said, no they weren’t included in this when it was the intent of the General Assembly when we put the program in place in the budget and when we calculated the $39.7 million, those people were already assumed by the General Assembly to be there and to be able to access those funds beginning January 1 of 2013. The only thing we’re doing, really, is just because we have to is making it clear to the department that those individuals have access, those individuals in group homes

Under 12270 to 5600 group owns those individuals impacted in PCs have the same access to the funds in the same qualifying ways individuals and adult Care Homes and the funds were sufficient, and believes community more than sufficient unto cover those additional individuals is not is not a separate program and all that she had just won in accent is explanation is that the problem still use the fact that they had to cut $39.7 million determine why we need to do with his guitar into the back steps (SPEAKER CHANGES) are we and the represented Blackwell represented claiming to represent things, I represented by banking and sheer but just let clarification on (SPEAKER CHANGES) how well the appeal process relations because the legislation was originally inherent dangers that the fund is available for people after their appeal has been determined and they are found to be ineligible and I understand people have gotten letters saying please assist you in determining your money eligible you got the right to appeal by your appealing you can continue to receive benefits by if you all from earlier determined to be a knowledgeable and the benefits you received during the appeal process may be subject to recovering from you is that your understanding is that people during the appeal process or a risk a lot of a lifelong goal any assets with which to (SPEAKER CHANGES) four that is not the way the process works during the appeal to a partially a risk, and nobody, correct some individualistic and backs on the all fallen in the anybody on the strength of the from the understanding of that money please speak up and that's never been minors, you bought about going back and see around assistant from departments and on by information to the committee on the heels of fourth thank you Liane (SPEAKER CHANGES) please CPR your head into downtown of guy I'd Nis additional Medical Systems and represent dollars of selling crack at these individuals are not pursuing address or the master beaten during the pregnancy of their appeal (SPEAKER CHANGES) I'm sure not unlike past but not all get a copy of a letter to constituents and I'd like to share with her on the head of the represent a plane for a motion with her. As are for a motion and cheaper. At the formation all we have one more week and representatives from a summary of the two men shared (SPEAKER CHANGES) my ballot to say that represented dollar deadly good job of explaining a very complex of issue in and clear terms of anhydrous trade commission against its hard and staff columnist I’m think that's dumb things like five E issues that they could represent Michelle is the data set aside and said as much can happen on July 1 and the work that we have to do between now and then making sure that people who have no wonder: who have no place to go and that may eventually Low and four frail elderly, they don't have to adapt the deficiencies in activities of daily living at the top qualifying for Medicaid how are we to the U.N. population if they can also a secondly that we wall to what you're getting restore Care Services cell with LB providers CA, because of that reduction of about 9:00 AM to bell had, I can keep you in this Christmas and more like 55583 are all getting letters about, from people who say that they had been told that they will be released at these portraits that we had really good staff here they can help with that were delicate question (two that there is one other thing that the town if you are low income elderly in turn help really and you ……

We have something in North Carolina that’s called institutional bias. So if you are elderly and you have income is 150 percent of the federal poverty level, you are eligible to enter into an adult care home and qualify for these personal care services, and the state county special assistance. If you choose to take that money and stay at home, you are only Medicaid eligible up to 100 percent of poverty level. So if people made only a little more than 100 percent of federal poverty level, it was to their advantage to go into the institution and CMS doesn’t like that either because they prefer for people to stay at home if they can. This is a complex issue. I think you’ve done a really good job of explaining it and this is the fix we need and I agree that the intention was to include a lot of the language originally said adult care homes including group homes. I think it was just a short error that didn’t get included in the technical corrections bills, though I think this is a good fix and I’m really happy that we’ve been able to put it in place before the deadline ran out. Thank you. [SPEAKER CHANGES] Representative Inskot, we thank you for your work and appreciate your comments. Truly. Representative Cleveland. [SPEAKER CHANGES] Thank you, Madam Chairman. Favorable report on House Bill 5. [SPEAKER CHANGES] We’re checking to make sure we’ve got the motion right before the floor. While we’re waiting on that, please remember that Representative Dollar had announced the explanation in discussion on finance and the UI Bill is in 544 and it’s continuing on there. Representative Cleveland, your motion has been accepted. Your procedures are correct. All those in favor of a favorable report for House Bill 5 will say, “Aye”. [SPEAKER CHANGES] Aye. [SPEAKER CHANGES] All those opposed? The ayes have it. I’ll turn this back over to Representative Nelson. Did you want to adjourn? No further business before us? I now declare this meeting adjourned.