Senior Tar Heel Legislature
2002 Legislative Priorities
- Priority 1: Maintain Home and Community
Care Block Grant services for impaired older adults at the current
Need for Legislative Action: In-home and
community-based services help impaired older adults stay in their
homes. Key services include home delivered meals, adult day care/day
health care, in-home aide, and respite care for family caregivers.
As the older population continues to grow, particularly the 85+ population
which is more likely to need these services, so does the demand for
services. Current resources are not adequate to meet the demand.
Although increased funding has been earmarked for in-home and community-based
services since 1995, there are currently over 10,000 older adults
on waiting lists for key services such as in-home aide services and
home delivered meals. An additional $1.3 million is needed to provide
a 3% inflationary increase in order to maintain services at the current
- Priority 2: Take steps to ensure that
the Medicaid Community Alternatives Program for Disabled Adults
(CAP/DA) remains a viable services for older and disabled adults
in our state and that our Medicaid program is strengthened to further
serve low income seniors.
Need for Legislative Action: The Medicaid
Community Alternatives Program for Disabled Adults (CAP/DA)
is one of four programs under Medicaid which provides home
and community care as a cost-effective alternative to institutionalization.
The program, which was implemented in 1982, provides a package
of services to allow disabled adults age 18 and older who qualify
for nursing home care to remain in their private residences.
In SFY 2001, the program served 12,901 people at less cost
than nursing home care. Two recent studies, the Lewin Groupís "North
Carolina Medicaid Benefits Study" and the North Carolina
Institute of Medicineís "Long Term Care Plan for North
Carolina" expound the worthiness and cost-saving nature
of CAP/DA. Because of the budget shortfall in the Medicaid
program, a freeze was placed on the CAP/DA program effective
October 1, 2001. Due to this freeze, individuals who would
prefer to stay in their homes may now be forced into more expensive
institutional placement. The freeze is a step backwards in
the stateís efforts to allow disabled adults choices in their
care options and in the stateís efforts to promote a continuum
of long term care services. The freeze is also not consistent
with the stateís efforts to adhere to the U.S. Supreme Courtís
Older and disabled adults in our state with
monthly income over $738 can not qualify for Medicaid without
meeting a "deductible" or "spend down".
In order to meet a "spend down", a person must incur
medical bills equaling or exceeding the difference between
their countable monthly income and $242 which is the medically
needy income limit. Older and disabled adults can also not
qualify for Medicaid if their countable assets exceed $2000.
We are well aware of the budget challenges facing our state,
however, we believe that the state needs to address the limitations
on the medically needy income limit and the asset level for
older and disabled adults.
- Priority 3: Examine the issue of workforce
shortages among paraprofessionals and professionals serving older
adults and people with disabilities.
Need for Legislative Action: North Carolina is in the midst
of a long-term care workforce crisis. Efforts to design a long-term
care system that ensures the availability of services and high quality
care are meaningless unless there is a supply of trained professional
and paraprofessional staff Ė including nurse aides, nurses, physicians,
dentists, and allied health professionals. North Carolina is projected
to need an additional 30,850 direct care workers between 1998 and
2008. We encourage the General Assembly to address the workforce
shortage issue and propose solutions for addressing this critical
- Priority 4: Pass legislation to strengthen
consumer protections to the citizens of North Carolina with special
focus on the areas of telemarketing fraud, identity theft, credit
practices, and home repair scams and study increasing civil and
criminal penalties for those who financially exploit older adults.
Need for Legislative Action: Consumer fraud, particularly
fraudulent practices targeted to older adults, is a growing problem.
Residents of our state loose millions of dollars each year as a result
of fraud and scams. In a one-week period, the Telemarketing Fraud
Prevention Project in the Attorney Generalís Office detected eight
different telemarketing fraud "hits" on seniors with total
payments amounting to $145,000. Consumer protections need to be strengthened
and penalties for those who financially exploit seniors need to be
increased. At this time, deceptive trade practice cases brought before
the Attorney General in state civil court under the Deceptive Trade
Practices Act (G.S. 75-1.1) are limited to civil penalties up to
a maximum of $5000 per violation.
- Priority 5: Examine the biases which favor
institutional placement over home and community based care for
older adults and people with disabilities.
Need for Legislative Action: The Long-Term Care Plan for
North Carolina submitted to the General Assembly in January of 2001
states that the stateís long-term care policy should be to support
older adults and people with disabilities and their families in making
their own choices with regard to living arrangements and long-term
care services that will result in appropriate, high quality, cost
effective care provided in the least restrictive environment. At
this time, there are many biases in our current system which favor
institutional placement thereby reducing the choices that older and
disabled adults and their families have. These biases need to be
Last update - October