North Carolina

This second report in a series focuses on how state variation in level of experience and infrastructure to undertake large-scale transition programs can affect implementation. The authors describe differences in strategies to 1) expand transition coordination capacity 2) locate appropriate housing 3) enhance long-term supports & services 4) change Medicaid HCBS programs/policies to ensure that those who transition can remain in the community after the MFP eligibility period ends.

The Network consists of 10 regional centers funded by the National Institute on Disability and Rehabilitation Research (NIDRR), a division of the U.S. Department of Education. The mission is to provide information and Technical Assistance on the Americans with Disabilities Act (ADA) to individuals, organizations and employers. They provide training materials, referrals, and a searchable database of legal documents, fact sheets and checklists.

Nearly every state provides at least some funds for services for low-income older adults or people with disabilities who have too many assets to qualify for Medicaid. AARP reports on how much each state spends on both multiservice and single-service programs. It also compares funding sources, eligibility criteria, services, cost management strategies, consumer direction, and other characteristics.

Medicaid currently fills in the gaps in Medicare’s benefit package for 8.8 million enrollees with limited income and resources (dual eligibles). Shifting aspects of this financing to the Federal government could save states money and create opportunities for better care management and coordination. Data tables show how much each state could save if certain financing roles were shifted.

This spreadsheet provides a list of ADRC program sites and information about which organizations are operating the ADRC and the services and functions they provide. The list is organzied by state and then country.

The study compares monthly income for people receiving Supplemental Security Income (SSI) to local median incomes and Fair Market Rent rates for modest units across the U.S. In 2008, there were 219 housing markets in 41 states where recipients of SSI, people with long-term disabilities and virtually no assets, would have to pay 100% of their income for a modest one-bedroom unit. Ten years ago there were 44 such markets in 13 states. Policy recommendations are given to reverse this trend.

Follow the link for a comprehensive listing of state statutes, regulations, policies, and procedures regarding the use of emergency or planned physical, chemical, mechanical, or other restraints. Additional documents offer information on positive behavior support guidelines, training manuals, and other policy-related materials. Many emphasize the use of positive or non-aversive interventions. Links are provided to access documents on many state DD agency websites.

Three key issues affecting the understanding of low rates of successful employment outcomes for people with mental illness are explored. These are: lack of a common definition of successful employment; lack of clear, objective, standardized data; and differences among states and programs in measuring client characteristics. Peer critiques to the data and analysis are provided along with tables comparing employment outcomes by state.

New York spends more than most states on Medicaid and long-term care. To understand why this is, the following traits are evaluated: demographics of residents over 65; poverty level; long-term care spending, budgets, and services; and quality of nursing home care. The findings identify a number of demographic and program factors likely contributing to the high rate of spending.

Money Follows the Person (MFP) programs only target 0.9% of the people that could be eligible for transitioning out of institutions each year. However, there is a potential to increase rates to 15-40% annually depending on quality of program implementation, who is targeted, and how successful states are in overcoming barriers to transitioning high-needs people. The report looks at grantee states’ potential for accomplishing this rate increase.