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Benchmarks' Member Webinar
August 14, 2020 |
NC Cases: 139,060
Cases Hospitalized: 1,104
NC Deaths: 2,312
NCCDD 5 Year Plan Survey
The NC Council on Developmental Disabilities wants to learn about the issues that are important to individuals with intellectual or other developmental disabilities (I/DD) across North Carolina and what NCCDD should work on for its next Five Year State Plan.
Benchmarks will be facilitation a discussion with membership to discuss recommendations. Please join us on:
Wednesday: August 19, 2020
Time: 9:00 am thru 10:00 am
CALL TO ACTION - Contact your Senate Congressmen!
We need your voices this week to press North Carolina's Senators to support some key components of the House version that will support your efforts to care for your clients.
Please reach out to:
We have outlined some key provisions we need to advocate for below. It would be VERY helpful for you to craft a personal email that includes support for all of the items below or the ones that impact your organization directly.
THANK YOU!!!!!!!!!!!!!!!
Paycheck Protection Program (PPP)
PPP was the financial relief necessary to keep my agency operating. Unfortunately, the PPP resources are soon to run out. We are in need of a second draw.
We are asking you to include a second draw of the PPP in the next relief bill and eliminate the requirement that my agency must have a 50% decrease in gross receipts. We serve (clients with substance use disorders) (clients with developmental disabilities) (children in the foster care system) needing care and support during this COVID-19 crisis.
While our gross receipts have decreased some, they have not decreased by 50%. HOWEVER, our costs have greatly increased.
My agency has had to offer employee incentives and overtime,pay for PPE, sanitation, and other expenses to cover the cost of regular testing for staff. So while our gross receipts have not decreased by 50%, our costs have increased tremendously. Just like our hospitals, our agency is required to do whatever it takes to care for our clients.
HCBS Increase
Keeping our clients safe and stable in the community during the COVID crisis is best for our clients and cost savings for our state. We strongly encourage you to support the 10% increase in funding for Home and Community-Based Services (HCBS), the largest program supporting people with I/DD.
FMAP increase
We have experienced increased costs in providing Medicaid services that can only be covered by increased rates. We need your support to increase the Federal Medical Assistance Percentage (FMAP) payments to state Medicaid programs by a total of 14 percentage points starting July 1, 2020 through June 30, 2021.
The FMAP increase specifically assists states for activities to improve home and community-based services and supports delivery. Funds can be used to increase and support direct support professionals (DSP) ** Members please share examples about your specific challenges in recruiting and retaining staff that has been exacerbated by COVID.***
Substance Abuse and Mental Health Services Increase
$3 billion to increase mental health support during this challenging time, to support substance abuse treatment, and to offer increased outreach.
Children and families in the child welfare system are experiencing unprecedented stress and challenges due to the COVID-19 pandemic. We need to ensure our child welfare system is able to meet the immediate needs of our children and families in crisis, and help families rebuild after the pandemic.
This bill was introduced last week. This legislation would provide funding for youth transitioning from foster care. While these young people have many challenges as they exit foster care, they are experiencing a multitude of challenges as they transition during this pandemic. Please support our young people exiting foster care by offering them assistance to give them a better start into adulthood.
Testing Requirements
Richard Craver, Winston-Salem Journal, 8/07/20
Staff members in North Carolina's long-term care facilities are being tested for COVID-19 on a biweekly basis, beginning immediately and running through at least November.
Dr. Mandy Cohen, the state's health secretary, issued a secretarial order Friday that shifted the staff testing requirement from recommended to mandatory. Long-term care facilities already were required to test staff weekly if a COVID-19 case has been detected. "North Carolina nursing home residents are among the most vulnerable to COVID-19 infection," Cohen said. Facilities will be required to report all test results. Federal CARES Act funding will be used to pay for the additional testing. DHHS reported that as of noon Saturday, at least 1,074, or 49.7%, of all COVID-19 deaths in the state have occurred in nursing home or residential care facilities.
Medicaid Expansion
Richard Craver, Winston-Salem Journal, 8/08/20
Another red state has chosen to expand Medicaid coverage via voter referendum, this time in Missouri on Tuesday. Meanwhile, North Carolina remains one of just 12 states that has not expanded health coverage, which also includes Alabama, Florida, Georgia, Mississippi, South Carolina and Tennessee.
Medicaid currently covers 2.2 million North Carolinians, with projections of expansion adding between 450,000 and 650,000 residents. Dr. Mandy Cohen, the state's health secretary, cited the Missouri referendum Wednesday in saying "it is time that North Carolina expands Medicaid."
School Reopenings
Keri Brown, WFDD RADIO, 8/07/20
A vast majority of K-12 public school students in North Carolina will learn remotely when school begins on August 17. Districts are looking to state and federal officials for more guidance on when it will be safe to reopen buildings.
New state data show at least 65% of public school students will start the year fully remote because their districts went with Plan C. Beyond that, an unknown number of parents have opted for remote instruction in districts that allowed for a mix of in-person and online learning. Gov. Roy Cooper says many districts that have taken the remote option are doing so temporarily and will reevaluate in-person learning if coronavirus spread decreases.
Mask Testing
RICHARD STRADLING, THE NEWS & OBSERVER, 8/10/20
Dr. Eric Westman was helping a Durham nonprofit organization provide free masks to people who need them when he decided he should find out whether the masks would really prevent the spread of coronavirus. But it wasn't simply a matter of searching online to see which masks worked best. This was April, and at that time researchers hadn't tested the variety of home-made masks and improvised face coverings that most people are wearing now, Westman said.
Westman, an associate professor at Duke University's medical school, asked the Duke physics department if it could test various types of masks and face coverings for him. The results, published Friday in the journal Science Advances, not only helped the nonprofit Cover Durham choose the right masks, Westman said, they also show that testing the effectiveness of face coverings is not all that difficult. And to the surprise of the Duke researchers, the study also found that some types of coverings are worse than wearing no mask at all.
Not surprisingly, the fewest droplets (almost zero) were detected with a fitted N95 mask, the ones used by doctors, nurses and other health care workers in the highest-risk settings. A surgical mask was a close second. Masks made of polypropylene also did very well, but so did various kinds of double-layer cotton masks. Several of the cotton masks produced less than 20% as many particles as someone wearing no mask at all.
Less effective was the bandana, which let through about 50% as many particles as someone not wearing a mask at all. But the worst performer was the gaiter, which people wear around their necks and pull up over their faces like a mask. The one the Duke team tested actually made things worse. Rather than preventing the droplets from escaping, it turned the larger droplets into a cloud of smaller ones that hung in the air longer.
Martin points out that the Duke researchers tested only one type of neck gaiter. In fact, he said, the study was never meant to be a comprehensive test of all masks and mask materials.
NC DHHS Legislative Presentations
On Tuesday, August 11 the NC General Assembly held a Joint Legislative Oversight committee on Health and Human Services in the morning and a Joint Legislative Oversight Committee on Medicaid and NC Health Choice in the afternoon. It was a full day of presentations which focused on COVID-19 response and progress in the am and Medicaid Transformation and the Medicaid budget in the pm.
State officials said North Carolina's COVID-19 data is hopeful, but they warned lawmakers against getting too hopeful too fast. "We have made progress but that progress is fragile," said Mandy Cohen, secretary of the N.C. Department of Health and Humans Services.
Cohen told lawmakers about four things still needed to combat COVID-19. The federal government must address continuing testing supply chain shortages and diversify testing, she said. And the state needs Medicaid expansion, a continued focus on marginalized populations and a plan for vaccination campaigns and distribution for next year.
Cohen said DHHS is using money from three funding sources to pay for the state's response to the virus. That includes $345 million from the CARES Act funding that the state legislature authorized for use with a Dec. 31 expiration date, $508 million from the CARES Act funds directed for use by the federal government with a lengthier timetable, and Medicaid funds.
Cohen said there were four categories where the money would be spent. They include supporting families, prevention, testing and tracing, and isolation support. "We know that the pandemic has impacted all of our lives," Cohen said. "And certainly those that were most vulnerable already and were really struggling already, this pandemic has really exacerbated some underlying issues."
But Cohen came to the meeting with good news for lawmakers. Cohen said taking "early and aggressive" action has stopped surges from happening here that she's seen in other states. "I know 6 months ago feels like six years ago, but we took early action to build up our response," Cohen said. She added that North Carolina skipped over the first surge expected in the spring, and the governor's mask mandate this summer helped prevent the second surge other states are now experiencing.
North Carolina received high marks from the Centers of Disease Control and the U.S. Department of Health and Human Services for testing strategies. The state focused efforts for testing on the uninsured, nursing homes and historically marginalized and under-served communities. The state averages 30,000 tests per day with an average three-day turnaround for results. Cohen said that the number of people seeking tests is dropping, and authorities are weighing whether that is because of summer vacations or the time required to get results back in July - which then averaged around a week.
Cohen told lawmakers that there is a difference between molecular tests and antigen testing, known as rapid testing. Cohen said rapid tests should only be performed on individuals who are symptomatic because it is good at telling if someone already has the virus, especially in the first five days, but can give false negative results. She said the molecular tests are the gold standard for getting accurate results.
Behind the scenes, Cohen said 647 people, 52% of whom are bilingual, have been hired through Community Care of NC to serve as contact tracers. Cohen said DHHS has partnered with FEMA to provide hotels, motels and dorms for people with unstable housing situations who need to isolate. Contact tracers are working with individuals to help supply housing, food or transportation to those who need it to ensure they can adequately quarantine.
Cohen said her department has also been working to modernize databases. That includes creating a way to report deaths electronically. Cohen said before the state was using legacy systems and COVID-19 has forced them to bring their systems to the current century. Cohen reminded lawmakers that COVID-19 is an active situation. She said data and funding can easily change and she would come back to update them if that happens.
Secretary Mandy Cohen reiterated her calls for Medicaid expansion. She argued that expanding Medicaid to 500,000-plus additional North Carolinians would help "maximize" the federal funding available to the state's fight against COVID-19. She said that had the state legislature approved Medicaid expansion last fall, North Carolina would get an additional $11.7 billion in federal dollars between 2020 and 2022. "We are spending money on things that Medicaid should be covering," she said. "I want to make sure we are accessing every tool that is out there."
Cohen said the economic downturn has increased the number of people who'd be eligible for expanded Medicaid beyond 500,000, but exact figures aren't available. She noted that Republicans in Missouri helped make it the 38th state to expand Medicaid. "It's an economic issue at this point," she said. "We are now competing with 38 other states that are taking billions of federal dollars to support their economies that we are not." Senate Republicans haven't wavered in their opposition to Medicaid expansion, citing concerns that it could create cost overruns and budget deficits in the future - particularly if the federal government stops paying 90% of the cost. None of the Republicans on the Medicaid oversight committee that Cohen spoke to addressed the issue or directly questioned her about the topic Tuesday.
DHHS officials said they're on track to meet the legislature's "aggressive timeline" to launch the long-delayed Medicaid Transformation project on July 1, 2021. The state expects that 1.6 million to 1.8 million Medicaid beneficiaries will shift from the current fee-for-service system to a managed care system, signing up for one of five Prepaid Health Plans during an open enrollment period next spring. Some Medicaid recipients with unique healthcare needs will stay in the fee-for-service system, which will be rebranded as "N.C. Medicaid Direct."
Dave Richard, a DHHS deputy secretary, said the transition process will be complicated by the COVID-19 pandemic. One area of concern is the contracts that the five Prepaid Health Plans must negotiate with individual healthcare providers. "It's going to be more difficult because of all of the challenges our providers face" in coping with coronavirus and its economic effects, Richard said. The goal is to ensure those contracts are finalized by the time open enrollment begins in March, and that the contracts in place ensure that every Medicaid recipient has "adequate" access to care.
DHHS is also working to reactivate the "enrollment brokers" who will guide Medicaid beneficiaries as they select the best Prepaid Health Plan for their needs. Medicaid beneficiaries won't be limited to the plan they'd previously picked, but the state has those choices on file in case someone wants to keep their original selection.
Sen. Jim Burgin, R-Harnett, asked if the state had saved money by delaying Medicaid Transformation. DHHS Secretary Mandy Cohen explained that "there is no cost savings (to making the switch) in the first three years" and "we actually have to pay out more money." The savings from Medicaid Transformation won't emerge until the third through fifth years of the new system.
Dr. David Hill, a pediatrician provided a presentation on the impact of COVID on children. A Korean study found that children ages 10 and up transmit the deadly virus as commonly as adults. Hill said 9% of children under 18 make up COVID-19 patients in the United States. But what's confusing for doctors is that children show different sets of symptoms than adults. Instead of respiratory complaints, children have abdominal pain, vomiting, diarrhea and rashes. "They're not presenting the respiratory complaints seen in adults," Hill said. Hill said hospitalization rates are also 95% lower than adults. "That is fantastic," Hill said. "That is what I love to hear because those are the people I take care of." Hill said very ill children seem to be those in the first 12 months of life.
And those who do end up hospitalized end up "quite sick," Hill said. Unique to children, multisystem inflammatory syndrome seems to affect children a week or two after COVID-19 and is similar to Kowasaki disease. The illness affects the heart and can be deadly. Fifteen of these cases have been identified in North Carolina in children 6 years and under.
Hill said most at risk are minority children or children in multi-generational households. "Many of the patients that I serve, especially in my poorer communities ... are in households where the primary caretaker of these children may be quite elderly," Hill said. "I have plenty of patients who are taken care of by great-grandparents so we need to be aware of transmission to these older communities." Hill said to fight the virus, children need to wear face masks, be separated into smaller groups, hold outdoor classes, wash hands and avoid high-touch surfaces. "We know we're going to get transmission," Hill said. "It's guaranteed. But can you limit it to a pod?" Hill said keeping kids in smaller groups could prevent having to close entire schools when infections occur.
For parents needing more care, Department of Health and Human Services Deputy Secretary Gale Perry said 90% of child care facilities have reopened. Perry said there are 30,000 openings at child care facilities around the state. "We know that families need help with finding childcare, as some childcare facilities have closed," Perry said. She told lawmakers that a hotline has been set up to help families find childcare facilities, even for school-aged children, in their area.
Handouts:
- JOINT LEGISLATIVE OVERSIGHT COMMITTEE ON HEALTH AND HUMAN SERVICES
- JOINT LEGISLATIVE OVERSIGHT COMMITTEE ON MEDICAID AND NC HEALTH CHOICE
Unemployment Benefits
WILL DORAN, THE NEWS & OBSERVER, 8/12/20
People out of work in North Carolina because of coronavirus - or any other reason - stopped receiving extra federal unemployment benefits about two weeks ago. But that could change soon. Gov. Roy Cooper said Wednesday he has begun the process to apply for a new program created by Republican President Donald Trump. Trump's plan will take FEMA disaster relief money and redirect it to unemployment benefits. It would give unemployed people $400 a week. The previous federal benefits of $600 a week stopped earlier this month, after Democrats and Republicans in Congress failed to negotiate a deal to keep it going.
For North Carolinians to get the new money will require bipartisan cooperation between Cooper, a Democrat who is in charge of the state's application, and the Republican-led legislature, which may need to help pay for North Carolina's 25% share of Trump's plan. Both sides appear committed to making it happen. On Wednesday, Cooper replied that he had started applying for the federal money.
