What Is the Issue? 

The Department of Justice did an investigation to determine if Adult Care Homes met the IMD (Institutions for Mental Disease) definitions which would then cause people living in homes with over 16 beds, between the ages of 21 and 64 to lose their medicaid if more than 50% of the residents have mental illness or substance abuse disorders.   

View the complaint HERE

The Agreement

• The Agreement will transform North Carolina's mental health system from one that is heavily reliant on large, institutional settings, to one that is focused on providing community-based services and housing that enable individuals to live, work, and participate fully in community life. 
• The Agreement provides community-based supported housing to 3,000 individuals unnecessarily segregated in, or at risk of entry into, adult care homes.  
• The Agreement also provides thousands of people with mental illness access to critical community-based mental health services - including Assertive Community Treatment (ACT) teams, crisis services and supported employment services.  The State will also implement a person-centered discharge planning process to help individuals transition to the community and a pre-admission screening process to prevent individuals from becoming unnecessarily institutionalized.

Read Full Agreement HERE

What NC Will Make Available to Comply with Agreement

• Community-Based Supported Housing
  • Provides at least 3,000 housing slots over eight years (by July 2020) to enable people with mental illness to transition to community-based supported housing and to ensure that those at risk of entering adult care homes will be offered supported housing in the community.
    • Starting July 1, 2013 the State will provide Housing Slots to at least 100 and up to 300 individuals, by July 1, 2014 slots provided to at least 150, 708 by July 1, 2015, 1,166 by 2016, and by July 1, 2020 Housing Slots will be provided to at least 3,000 individuals.
    • Housing slots are a package of housing vouchers or rental subsidies, tenancy supports, and transition supports that enable residents to maintain integrated, affordable supported housing.
    • Community-based supported housing is permanent housing with tenancy rights, where individuals have access to flexible support services as needed and desired.  Supported housing affords individuals choice in their daily lives and enables them to interact with individuals without disabilities to the fullest extent possible.
• Community-Based Mental Health Services
  • Ensures that individuals with mental illness receive the array and intensity of services to enable them to successfully transition to, and remain in, community-based settings.  These services include ACT, Community Support Teams, case management services, peer support services, and psychosocial rehabilitation services.
    • Following a nationally recognized fidelity model, the number of ACT teams throughout the State will expand to 50 ACT teams with the capacity to serve 5,000 individuals by July 1, 2019.(Deby Dihoff has been selected to serve on the ACT Committee - NAMI NC will be at the table!)
    • Requires development of a crisis service system that offers timely and accessible services and supports in the least restrictive setting, including mobile crisis teams, walk-in crisis clinics, short-term community hospital beds, and 24/7 crisis hotlines. 
    • Significant expansion of supported employment - by 2019 will serve 2,500 people - which assists individuals in preparing for, identifying, and maintaining integrated, paid, competitive employment.
• Discharge Planning and Diversion Process
  • Implements procedures for discharge planning that ensure that individuals with serious mental illness in, or later admitted to, an adult care home or State psychiatric hospital are fully informed about all community-based options, including supported housing.
  • Provides each individual with serious mental illness in, or later admitted to, an adult care home or State psychiatric hospital with a written, person centered discharge plan.    
• Thank you to Jennifer Mathis from the Bazelon Center for her work on the fact sheet that helped make this Heard in the Halls possible.

Adult Care Homes Special Provision

Blue ribbon commission to study need to transition people to community housing. Sets aside $10.3 M for transition funds.   Additional $39 M to assist adult care homes.  State may pay for those who are no longer Medicaid eligible to stay for up to three months ($694/mo) phases out as of June 30 , 2013.