Overview of Gov. Cooper’s HHS Budget Proposal

1. Overview of Gov. Cooper’s HHS Budget Proposal DSS Director Monthly Call March 27, 2019 Michael Leighs Director of Intergovernmental Affairs NC Department of Health and Human Services

2. Overview of State Budget Process • Long Session: Biennial Budget Development • Governor’s Recommended Budget Released March 6th • HHS Appropriations Joint Committee Hearings • Next Steps Presentation sources: • Governor’s Recommended Budget, 2019-21 https://www.osbm.nc.gov/budgetbook_2019-21 • March 13, 2019 Presentation to Joint HHS Appropriations Committee, Office of State Budget and Management DSS DIRECTOR MONTHLY CALL | March 27, 2019

3. Budget Proposal Overview • Proposed FY 19-20 DHHS Budget of $24.4 billion ($5.7b in state appropriations) • Key Investments: • Child Development and Well-Being • Supporting Vulnerable Populations • Investments in IT and Infrastructure • Medicaid Transformation • Medicaid Expansion • Fighting the Opioid Epidemic DSS DIRECTOR MONTHLY CALL | March 27, 2019

4. Child Development & Well-Being DSS DIRECTOR MONTHLY CALL | March 27, 2019

5. Child Development & Well-Being • $15m recurring and $5m non-recurring for Smart Start • Focus on expanding evidence-based, family strengthening and home visiting programs • Adds approx. 2,300 subsidized child care slots • Building NC Pre-K capacity • Increases average reimbursement rate by 8% • Increases administrative support by 2% • Continued NC Pre-K expansion DSS DIRECTOR MONTHLY CALL | March 27, 2019

6. Child Development & Well-Being Child Welfare Training • Invests in 11 DHHS Child Welfare positions to improve training, CQI through onsite TA to counties, and accountability for better outcomes for children and families • Includes $750k to purchase web-based training for state and county use Intensive Family Preservation Services • $2.9m in recurring funding for evidence-based intensive family preservation services • Would serve an estimated 426 additional families DSS DIRECTOR MONTHLY CALL | March 27, 2019

7. Supporting Vulnerable Populations DSS DIRECTOR MONTHLY CALL | March 27, 2019

8. Supporting Vulnerable Populations Aging and Adult Services • Continues non-recurring funding for the Home and Community Care Block Grant • Adds almost $900,000 for Adult Protective Services from the Social Services Block Grant Transition to Community Living • Increases funding by more than $1.3m for the biennium to support eligible adults with mental illness in transitioning from institutions to community care settings DSS DIRECTOR MONTHLY CALL | March 27, 2019

9. Supporting Vulnerable Populations Establishes Office of Healthy Opportunities • Efforts will address the conditions in which people live that impact up to 80% of a person’s health including: • Food insecurity • Housing instability • Transportation needs • Interpersonal violence Supporting Local Food Banks • $1m to assist food banks with the increased demand from recent hurricanes and other natural disasters DSS DIRECTOR MONTHLY CALL | March 27, 2019

10. NC FAST/ Investments in IT and Infrastructure DSS DIRECTOR MONTHLY CALL | March 27, 2019

11. NC FAST Project Development • $9.2m to initiate NC FAST enhancements to provide: • 24/7 access to the system • Cloud-based computing solutions • Continued development and improvements to the child welfare case management system • Enhanced program integrity and security through a document management system Operations and Maintenance • Funds operations and maintenance, additional technical assistance, and provider help desk staff to support new NC FAST functionality DSS DIRECTOR MONTHLY CALL | March 27, 2019

12. Transforming Medicaid and Health Choice DSS DIRECTOR MONTHLY CALL | March 27, 2019

13. Medicaid & Health Choice Transformation • $161m over the biennium for the Fee-For-Service Claims Runout • $107m over the biennium for Managed Care implementation including: • Enrollment broker • Ombudsman • Centralized provider data management • Finance and program integrity • Medicaid Transformation Reserve will have a minimum balance of $132m at the end of the biennium DSS DIRECTOR MONTHLY CALL | March 27, 2019

14. Medicaid Expansion DSS DIRECTOR MONTHLY CALL | March 27, 2019

15. Medicaid Expansion Closing the Coverage Gap • Provides access to affordable health insurance to 500,000 North Carolinians • Requires no state funds, as federal government pays 90% and rest would be paid by hospitals and health plans Existing Medicaid Eligibility Enrollment Increase • $15.7m in FY19-20 and $34m in FY20-21 to support projected enrollment increases in Medicaid DSS DIRECTOR MONTHLY CALL | March 27, 2019

16. Fighting the Opioid Epidemic DSS DIRECTOR MONTHLY CALL | March 27, 2019

17. Fighting the Opioid Epidemic • Directs $15m of Medicaid funding to expand treatment and services for individuals with Opioid Use Disorders • $11.9m over the biennium to expand the continuum of services for individuals fighting opioid and other substance use disorders • Establishes 8 FTEs to improve substance abuse treatment and recovery services including: • Oversight and monitoring of opioid treatment programs • Administering the Substance Abuse Prevention and Treatment Block Grant DSS DIRECTOR MONTHLY CALL | March 27, 2019

18. Questions? Michael.leighs@dhhs.nc.gov (919) 855-4863 DSS DIRECTOR MONTHLY CALL | March 27, 2019