North Carolina Study Commission on Aging : report to the... General Assembly of North Carolina... session

              NORTH CAROLINA
STUDY COMMISSION ON AGING
REPORT TO THE
GOVERNOR AND THE 2010 REGULAR SESSION OF THE
2009 GENERAL ASSEMBLY
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North Carolina
Study Commission On Aging
May 11, 2010
To: Governor Beverly Perdue
Lieutenant Governor Walter Dalton, President of the North Carolina Senate
Senator Marc Basnight, President Pro Tempore of the North Carolina Senate
Representative Joe Hackney, Speaker of the North Carolina House of Representatives
Members of the 2010 Regular Session of the 2009 General Assembly
Attached is a report from the North Carolina Study Commission on Aging submitted pursuant to
North Carolina General Statute §120-187. The report contains recommendations and proposed
legislation from the North Carolina Study Commission on Aging based on study conducted after
the adjournment of the 2009 Regular Session of the General Assembly.
Respectfully submitted,
___________________________ ___________________________
Senator A.B. Swindell, IV Representative Jean Farmer-Butterfield
Co-Chair Co-Chair
1
North Carolina Study Commission On Aging
2009-2010 Membership List
President Pro Tempore's Appointments
Speakers' Appointments
Senator Albin B. Swindell, IV, Co-Chair Representative Jean Farmer-Butterfield, Co-Chair
Senator Stan Bingham
Representative Alice Bordsen
Senator Katie Dorsett
Representative Bob F. England, MD
Senator James Forrester
Representative Garland Pierce
Senator Joe Sam Queen
Representative Jennifer Weiss
Mr. John Eller
Ms. Mary Barker
Mr. Anthony Peace
Ms. Joan Pellettier
Ms. Jean Reaves
Ms. Patricia Sprigg
Ex Officio:
Ms. Maria Spaulding, Deputy Secretary,
Long-Term Care and Family Services,
Department of Health and Human Services
Clerks:
Delta Prince
919/733-5649
Janice Mobley-Bennett
919/733-5780
Staff:
Theresa Matula,
Sara Kamprath,
Shawn Parker,
Susan Barham
Research Division
919/733-2578
Melanie Bush
Fiscal Division
919/733-4910
Joyce Jones
Bill Drafting Division
919/733-6660
2
North Carolina Study Commission on Aging
Report to the Governor and the 2010 Session of the 2009 General Assembly 3
TABLE OF CONTENTS
LETTER OF TRANSMITTAL..................................................................................................1
MEMBERSHIP LIST.................................................................................................................2
PREFACE .................................................................................................................................5
EXECUTIVE SUMMARY.........................................................................................................6
AGING NORTH CAROLINA: THE 2008 PROFILE, UPDATED .........................................8
COMMISSION PROCEEDINGS ..............................................................................................18
COMMISSION RECOMMENDATIONS .................................................................................25
APPENDICES
APPENDIX A..............................................................................................................................35
Summary of Public Hearings, Spring 2010
APPENDIX B .............................................................................................................................39
Legislative Proposals
2009-SHZ-20 AN ACT TO REQUIRE THE HEARING AID DEALERS AND FITTERS BOARD TO
COORDINATE A TASK FORCE THAT WILL DEVELOP GUIDELINES FOR CONSUMERS TO
USE WHEN PURCHASING A HEARING AID, AS RECOMMENDED BY THE NORTH
CAROLINA STUDY COMMISSION ON AGING.
2009-SHZ-21 AN ACT TO DIRECT THE DIVISION OF HEALTH SERVICE REGULATION,
DEPARTMENT OF HEALTH AND HUMAN SERVICES, TO COORDINATE A REVIEW OF THE
EDUCATION AND TRAINING REQUIREMENTS FOR NURSE AIDES, AS RECOMMENDED BY
THE NORTH CAROLINA STUDY COMMISSION ON AGING.
2009-SHZ-25 AN ACT TO IMPLEMENT THE LONG-TERM CARE PARTNERSHIP PROGRAM, TO
ENSURE THAT NORTH CAROLINA'S LONG-TERM CARE INSURANCE LAWS COMPORT
WITH THE LONG-TERM CARE PARTNERSHIP PROVISIONS IN THE FEDERAL DEFICIT
REDUCTION ACT OF 2005, AND TO AUTHORIZE THE SHARING OF CONFIDENTIAL
INFORMATION BETWEEN THE NORTH CAROLINA DEPARTMENT OF INSURANCE,
ENTITIES THAT CONTRACT WITH THE FEDERAL GOVERNMENT, AND OTHER
GOVERNMENTAL AGENCIES, AS RECOMMENDED BY THE NORTH CAROLINA STUDY
COMMISSION ON AGING.
2009-SHZ-22 AN ACT TO ADD A LICENSED DENTIST TO THE COMMISSION ON CHILDREN
WITH SPECIAL HEALTH CARE NEEDS, AS RECOMMENDED BY THE NORTH CAROLINA
STUDY COMMISSION ON AGING.
2009-SHZ-23 AN ACT TO DIRECT THE NORTH CAROLINA AREA HEALTH EDUCATION
CENTERS (AHEC) PROGRAM TO COORDINATE WORKFORCE DEVELOPMENT EFFORTS TO
INCREASE THE NUMBER OF DENTAL CARE PROVIDERS SERVING THE SPECIAL NEEDS
POPULATION, AS RECOMMENDED BY THE NORTH CAROLINA STUDY COMMISSION ON
AGING.
North Carolina Study Commission on Aging
Report to the Governor and the 2010 Session of the 2009 General Assembly 4
2009-SHZ-24 AN ACT TO REQUIRE THE DIVISION OF MEDICAL ASSISTANCE, AND THE
DIVISION OF PUBLIC HEALTH, IN THE DEPARTMENT OF HEALTH AND HUMAN SERVICES,
TO EXPLORE ISSUES RELATED TO PROVIDING DENTAL SERVICES TO THE SPECIAL
NEEDS POPULATION, AS RECOMMENDED BY THE NORTH CAROLINA STUDY
COMMISSION ON AGING.
2009-SHZ-26 AN ACT TO UPDATE AND CLARIFY NORTH CAROLINA'S GENERAL STATUTES
ON OLDER ADULTS AND LONG-TERM SERVICES AND SUPPORTS, AS RECOMMENDED BY
THE NORTH CAROLINA STUDY COMMISSION ON AGING.
2009-SHZ-27 AN ACT TO DIRECT THE DIVISION OF AGING AND ADULT SERVICES,
DEPARTMENT OF HEALTH AND HUMAN SERVICES, TO STUDY THE ISSUE OF CRIMINAL
HISTORY RECORD CHECKS FOR CURRENT AND PROSPECTIVE OWNERS, OPERATORS,
AND VOLUNTEERS OF ADULT DAY CARE PROGRAMS AND ADULT DAY HEALTH
SERVICES PROGRAMS, AS RECOMMENDED BY THE NORTH CAROLINA STUDY
COMMISSION ON AGING.
North Carolina Study Commission on Aging
Report to the Governor and the 2010 Session of the 2009 General Assembly 5
PREFACE
Chapter 120, Article 21, of the North Carolina General Statutes, charges the North Carolina Study
Commission on Aging with studying and evaluating the existing system of delivery of State
services to older adults and recommending an improved system of delivery to meet the present and
future needs of older adults. The Commission consists of 17 members. Of these members, eight
are appointed by the Speaker of the House of Representatives, and eight are appointed by the
President Pro Tempore of the Senate. The Secretary of the Department of Health and Human
Services, or the Secretary’s designee, serves as an ex officio, non-voting member.
This report represents the work of the North Carolina Study Commission on Aging during the 2009-
2010 interim. The Commission met on seven occasions and held public hearings in Jamestown, and
Charlotte. The public hearings were conducted during March and April and provided citizens with
an opportunity to speak to Commission members about programs and services for older adults.
Based on reports and presentations received by the Commission, and comments expressed by
citizens, the Study Commission on Aging presents the recommendations contained in this report.
North Carolina Study Commission on Aging
Report to the Governor and the 2010 Session of the 2009 General Assembly 6
EXECUTIVE SUMMARY
The North Carolina Study Commission on Aging met seven times and conducted two public
hearings during the 2009-2010 interim. In response to the study and evaluation of services to older
adults, the North Carolina Study Commission on Aging makes the following recommendations to
the Governor and the 2010 Session of the 2009 General Assembly:
Recommendation 1: Maintain HCCBG Funding
The Study Commission on Aging recommends the General Assembly and the Governor maintain
funding levels appropriated for FY 2010-2011 to the Department of Health and Human Services for
the Home and Community Care Block Grant (HCCBG).
Recommendation 2: Maintain Funding for Senior Centers, Project C.A.R.E., and Other Vital
Support Programs and Services
The Study Commission on Aging recommends the General Assembly and the Governor maintain
current funding levels for senior centers and Project C.A.R.E. as well as many other vital programs
that provide aging services and support systems for older adults and their families.
Recommendation 3: Hearing Loss Treatment Task Force
The Study Commission on Aging recommends the General Assembly direct the Hearing Aid
Dealers and Fitters Board to coordinate a task force including representatives of the Division of
Services for the Deaf and Hard of Hearing in the Department of Health and Human Services, the
Consumer Protection Division of the Office of Attorney General, and other interested stakeholders,
to: 1) develop recommended guidelines for consumers seeking assistance in the treatment of hearing
loss, 2) make recommendations on the best way to disseminate these guidelines, and 3) report to the
Study Commission on Aging on or before October 15, 2010.
Recommendation 4: Review of Nurse Aide Training Requirements
The Study Commission on Aging recommends the General Assembly direct the Division of Health
Service Regulation, Department of Health and Human Services (DHHS), to coordinate a review
involving an equal number of representatives from the Division of Aging and Adult Services,
DHHS; the NC Board of Nursing; the Direct Care Workers Association; NC Health Care Facilities
Association; NC Hospital Association; NC Home and Hospice Care Association; and
representatives of residents in long-term care; to assess the current training requirements for nurse
aides and to recommend any necessary changes to the Study Commission on Aging on or before
November 1, 2010.
Recommendation 5: Long-Term Care Partnership Program
The Study Commission on Aging recommends the General Assembly enact legislation to develop a
Long-Term Care Partnership (LTCP) program for North Carolina and direct the Division of
Medical Assistance, Department of Health and Human Services, to pursue a State Plan amendment
allowing the operation of the LTCP program.
North Carolina Study Commission on Aging
Report to the Governor and the 2010 Session of the 2009 General Assembly 7
Recommendation 6: Include Dentist on the Commission on Children with Special Health Care
Needs
The Study Commission on Aging recommends the General Assembly expand the membership of
the Commission on Children with Special Health Care Needs to include a dentist.
Recommendation 7: Special Needs Dental Care Workforce Development
The Study Commission on Aging recommends the General Assembly direct the North Carolina
Area Health Education Centers (AHEC) Program to: 1) work with the dental schools at The
University of North Carolina – Chapel Hill and East Carolina University, the North Carolina
Community College System, and current special care dental providers to increase the available
workforce willing to treat North Carolina special care populations; 2) work with the NC State Board
of Dental Examiners to explore the feasibility of allowing dental students, dental hygiene students,
and assisting students the opportunity to receive training in long-term care facilities under the
direction of non-profit special care dental organizations; and 3) report to the Study Commission on
Aging on or before August 1, 2011.
Recommendation 8: Medicaid Dental Services
The Study Commission on Aging recommends the General Assembly maintain Medicaid funding
for dental services and direct the Division of Medical Assistance and the Division of Public Health
to: 1) explore the feasibility of expanding Medicaid dental services to include reimbursement for
evidenced-based fluoride and periodontal therapies for high risk adults with special health care
needs, 2) explore the implementation of facility code policies that would allow certified providers to
bill for each patient seen in a long-term care facility or group home on the date of service, and 3)
report on or before November 15, 2011 to the Study Commission on Aging.
Recommendation 9: Additional Mobile Dental Units
The Study Commission on Aging recommends the Department of Health and Human Services and
the special care mobile dental providers explore private grants and public federal government
funding options for the purchase of additional mobile dental units to serve special care populations.
Recommendation 10: Refining Aging and Long-Term Care Statutes in NC
The Study Commission on Aging recommends the General Assembly update and refine North
Carolina's General Statutes on aging and long-term care.
Recommendation 11: Adult Day Care Participant Protection
The Study Commission on Aging recommends the General Assembly amend North Carolina's
General Statutes to strengthen the authority of the Department of Health and Human Services to
ensure that unfit individuals are prohibited from operating or working in adult day care programs.
North Carolina Study Commission on Aging
Report to the Governor and the 2010 Session of the 2009 General Assembly 8
AGING NORTH CAROLINA:
The 2008 Profile, Updated
Prepared by the Department of Health and Human Services, Division of Aging and Adult Services
North Carolina’s Demographic Shift: North Carolina remains in the midst of a significant
demographic change as the State’s 2.3 million baby boomers (those born between 1946 and 1964)
are beginning to enter retirement age. Today, the proportion of the State’s population who are
seniors, ages 65 and older, is 12.3 percent. By 2029, when the youngest baby boomers are
retirement age, the proportion should reach 15.2 percent or 1.9 million older North Carolinians,
including the surviving boomers who will be between ages 65 and 83. Figure A shows the
milestones of the baby boomers expressed in terms of some major federal and State age-related
programs (eligibility age in parenthesis). For example in 2006, the oldest boomers (i.e., born in
1946) became eligible to receive services under the Older Americans Act, and as of January of
2008, some of the oldest boomers began receiving their first Social Security payments.
Figure A: Baby Boomer Milestones
Year when oldest boomers become eligible
Programs 2006 2007 2008 2009 2010 2011 2012
NC Senior Games participation (55)
Older Americans Act services (60)
Social Security at a reduced rate (62)
Medicare benefits (65)
Medicaid assistance for the Aged (65)
Full Social Security (66)
Figure B: Growth of Older North Carolinians Age 65+ (2000-2029)
Based on 2008, Demographic Unit, Office of State Budget and Management, projections April 2000-July 2029
The impact of the aging baby boomers is clearly indicated in the projected growth of North
Carolinians age 65+ between 2010 and 2029 as shown in Figure B. [1]
969,048
1,202,765
1,687,883
2,194,126
2000 2010 2020 2029 0
500,000
1,000,000
1,500,000
2,000,000
2,500,000
North Carolina Study Commission on Aging
Report to the Governor and the 2010 Session of the 2009 General Assembly 9
Figure C shows the projected growth of the older population by county between 2008 and 2029.
During this period, growth for the State as a whole is projected at 38 percent, while the population
65 and older is expected to grow 93 percent, and the population 85 and older, 54 percent. [1] The
two counties with more than 200 percent growth, Wake, and Union, and the three counties with 150
to 161 percent growth, Johnston, Mecklenburg, and Orange are experiencing rapid growth in their
overall population as expanding parts of metropolitan areas.
New
Alexander
Alleghany
Ashe
Avery
Buncombe
Burke
Cabarrus
Caldwell
Catawba
Cherokee
Cleveland
Davie
Gaston
Graham
Haywood
Henderson
Iredell
Jackson
McDowell
Macon
Madison
Mecklenburg
Mitchell
Polk
Rowan
Rutherford
Surry
Swain
Union
Watauga Wilkes
Yadkin
Yancey
Clay
Transylvania
Lincoln
Granville
Nash
Alamance
Anson
Bladen
Caswell
Chatham
Columbus
Cumberland
Davidson
Durham
Forsyth Franklin Guilford
Harnett
Hoke
Lee Johnston
Montgomery Moore
Orange
Person
Randolph
Richmond
Robeson
Rockingham
Sampson
Scotland
Stanly
Stokes
Vance
Wake
Warren
Beaufort
Bertie
Carteret
Chowan
Craven
Dare
Duplin
Edgecombe
Gates
Greene
Halifax Hertford
Hyde
Jones
Lenoir
Martin
Hanover
Northampton
Onslow
Pamlico
Pasquotank
Pender
Perquimans
Pitt
Tyrrell
Brunswick
Washington
Wayne
Wilson
Camden
Currituck
Greater than 200%
150 to 200% increase
100 to 149% increase
50 to 99% increase
Figure C. Projected Growth of Population Ages 65 and Older from 2008 to 2029
Source: Based on 2008 and 2029 projections from Office of State Budget and Management, September 2009
Range: 14% -255%
14 to 49% increase
North Carolina Study Commission on Aging
Report to the Governor and the 2010 Session of the 2009 General Assembly 10
New
Alexander
Alleghany
Ashe
Avery
Buncombe
Burke
Cabarrus
Caldwell
Catawba
Cherokee
Cleveland
Davie
Gaston
Graham
Haywood
Henderson
Iredell
Jackson
McDowell
Macon
Madison
Mecklenburg
Mitchell
Polk
Rowan
Rutherford
Surry
Swain
Union
Watauga Wilkes
Yadkin
Yancey
Clay
Transylvania
Lincoln
Granville
Nash
Alamance
Anson
Bladen
Caswell
Chatham
Columbus
Cumberland
Davidson
Durham
Forsyth Franklin Guilford
Harnett
Hoke
Johnston
Lee
Montgomery Moore
Orange
Person
Randolph
Richmond
Robeson
Rockingham
Sampson
Scotland
Stanly
Stokes
Vance
Wake
Warren
Beaufort
Bertie
Carteret
Chowan
Craven
Dare
Duplin
Edgecombe
Gates
Greene
Halifax Hertford
Hyde
Jones
Lenoir
Martin
Hanover
Northampton
Onslow
Pamlico
Pasquotank
Pender
Perquimans
Pitt
Tyrrell
Brunswick
Washington
Wayne
Wilson
Camden
Currituck
More than 25%
Less than 20%
20 to 25%
Figure D. Percent of County Population Projected to be Ages 65 and Older in 2029
Source: Based on 2029 projections from Office of State Budget and Management, September 2009
Range: 10% - 29%
Figure D shows the counties that will have the largest concentration of older adults in 2029. The
proportion of the State population made up of older adults aged 65+ for the State is 17%. Most of
them are in areas attractive to retirees, but many are also counties that will continue to lose younger
residents because of modest economic opportunities.
Although decreases in both fertility and mortality are the major factors in the aging of the State’s
population, migration also plays a key role. Several factors contribute to the different rates of aging
of the State’s 100 counties.
 Rural-to-urban migration of young adults continues to age rural counties.
 Large metropolitan counties attract large numbers of persons from outside the State, as well
as from rural counties, and are experiencing greater growth.
 A large number of older adults with higher incomes are retiring in some western and coastal
counties and other counties with attractions to specific groups of older adults (e.g., golf
courses).
 Some of the counties are also experiencing an increase in the immigrant and refugee
population. [2]
Along with other Sunbelt states (Florida, South Carolina, Texas, Tennessee, Georgia, and Virginia),
North Carolina remains a popular destination for people of all ages, including seniors. [3]
The table below compares later-life migrants, both those native to North Carolina and those born
outside the State, to resident seniors. Later-life migrants are non-institutionalized persons over the
North Carolina Study Commission on Aging
Report to the Governor and the 2010 Session of the 2009 General Assembly 11
age of 60 who reportedly have moved across state lines. In 2006, among non-institutionalized
North Carolinians aged 60 and older, an estimated 27,606 had arrived from out of State within the
previous year. The data suggest that later-life migrants born outside North Carolina are somewhat
younger, less likely to be disabled, nearly twice as likely to have a college degree, and report
substantially higher family income. [4]
Table 1. Demographic Profile of Later-Life Migrants and Resident Seniors for
North Carolina as a Whole, 2006
Aged
60-64
Aged
65-74
Aged 75
and older Diabled Married
College
Degree White Homeowner
Median
Family
Income
Later-life Migrants, non-natives 30.8% 42.8% 26.4% 37.5% 49.2% 34.5% 84.1% 48.4% $56,800
Later-life Migrants, NC natives 50.8% 33.7% 15.4% 34.4% 41.1% 25.4% 64.3% 68.0% $42,000
Resident Seniors 28.8% 39.5% 31.7% 39.4% 59.4% 19.0% 82.1% 80.8% $45,000
Source: 2006 American Community Survey Public Use Microdata Sample (PUMS)
The contributions of Dr. Don Bradley from East Carolina University to this report highlight aspects
of later-life migration and suggest important implications for North Carolina of retirees moving to
our State and within our State.
According to the most recent life tables from the NC State Center for Health Statistics, if age-specific
mortality remains unchanged, babies born today in North Carolina are expected to live, on
average, to the age of 77.1 years. The North Carolinians who are age 60 today are expected to live,
on average, an additional 22.2 years to almost 82 years old. Generally, women live longer than men
and whites live longer than persons of other racial groups. However, at the oldest ages, African
Americans, in particular, have a life expectancy that is the same or slightly greater than that of
whites. This is known as the “crossover effect.” [5]
Table 2. Life Expectancies (in Years) by Age Group, Gender, and Race
NC White African-American
Age Groups Combined Male Female Male Female
(At Birth) 77.1 75.3 80.5 69.8 76.7
60-64 22.2 20.8 24.0 18.1 22.3
65-69 18.4 17.1 19.9 15.1 18.7
70-74 15.0 13.7 16.1 12.4 15.5
75-79 11.9 10.8 12.7 10.1 12.4
80-84 9.2 8.4 9.6 8.3 9.8
85+ 7.1 6.6 7.2 6.9 7.7
Source: NC Center for Health Statistics. Life Expectancy in North Carolina, 2005-2007
What Are the Implications of This Shift? The aging of the population is a national and
international trend, and North Carolina, like the rest of the world, must be prepared to reap the
benefits and face the challenges of an older population. Government faces decisions about the
North Carolina Study Commission on Aging
Report to the Governor and the 2010 Session of the 2009 General Assembly 12
allocation of public resources from a tax base that may experience slowed growth, especially in
many aging rural counties. People must consider living and caregiving arrangements in light of
smaller nuclear and extended families. The health, human service, employment, and education
systems must adapt to the changing needs and interests of the seniors of today and tomorrow. The
business and faith communities as well as others must identify and respond to the challenges and
opportunities of these demographic shifts.
In the 2003-2007 State Aging Services Plan, the NC Division of Aging and Adult Services
introduced a new initiative–Livable and Senior-Friendly Communities–to raise awareness of the
aging of our population. The initiative was also designed to encourage North Carolina’s
communities toward becoming more senior-friendly as well as livable for all people through
collaboration among citizens, agencies, organizations, and programs, in both the public and private
arenas. This initiative formed the core around which the 2007–2011 State Aging Services Plan was
organized. A livable and senior-friendly community in North Carolina will draw on the talents and
resources of active seniors while enhancing services for those who are vulnerable because of their
health, economic hardships, social isolation, or other conditions. A livable and senior-friendly
community will work to address a wide range of issues and concerns (e.g., air quality, housing,
long-term services and supports, employment, enrichment opportunities) that, as a whole, affect the
quality of life of seniors and others in the community. Also, a livable and senior-friendly
community will assure good stewardship of its resources to meet the needs of today’s seniors, while
helping baby boomers and younger generations prepare for the future.
Demographic Highlights
Population: North Carolina ranks tenth among states in the number of persons age 65 and older and
tenth in the size of the entire population. [6] The fast pace of growth of the State’s older population
is evident in a US Census Bureau’s release in which North Carolina was ranked fourth nationally in
the increase of the number of persons age 65+ (47,198 in NC) between April 2000 and July 2003.
Only three other states (California, Texas, and Florida) reported a greater increase among their older
populations. Even so, when combined with the equally strong growth in other age groups, North
Carolina continues to maintain an overall healthy demographic balance among the generations, as it
is thirty-sixth among states in the proportion of the population over 65. [7]
 Estimated NC population age 65+ in 2008: 1,139,468 (12.3 percent of total population)
 Estimated NC population age 85+ in 2008: 138,632 (1.5 percent of the total population)
Diversity and Disparity: North Carolina is rich in diversity, but its citizens face challenges because
of the disparity that exists among all populations, including older adults. Some important
differences among NC’s older adults relate to gender, marital status, ethnicity/race, poverty,
residence, rurality, disability, health status, grandparents raising grandchildren, and veteran status.
Gender: Older women represent 57.7 percent of the 65+ age group and 70.6 percent of the 85+ age
group in 2008. [8] The higher rate of poverty among older women remains a primary issue today.
For example, women age 75+ are twice likely to be poor as men the same age. [9]
North Carolina Study Commission on Aging
Report to the Governor and the 2010 Session of the 2009 General Assembly 13
Figure E. Percentage of Older Adults by Gender and Age
Marital Status: Since women live longer than men, aging brings the increasing likelihood of
widowhood, for women. Because men have shorter life expectancy, and because they tend to marry
younger women, at ages 65 and older, women are more than twice as likely to be unmarried as men
in their age group. Data show that being unmarried (widowed, divorced, separated, or never
married) increases a woman’s vulnerability to poverty. [10]
Table 3. Unmarried Older Adults by Gender and Age Group
Age 65-74 Age 75-84 Age 85+
Unmarried Women in NC 47.1 67.4 91.5
Unmarried Men in NC 24.6 29.4 49.7
Source: American Community Survey (2008). Table B12002.
Ethnicity/Race: Altogether 19.1 percent of persons age 65+ are members of ethnic minority groups
in North Carolina. Compared to the nation as a whole, North Carolina’s population age 65+
includes a larger proportion who are African American (15.6 percent in NC compared to 8.3 percent
nationally) and a smaller proportion of Latinos (1.5 percent in NC compared to 6.8 percent
nationally). American Indians, Asian Americans, and other ethnic groups account for 2.0 percent of
the age group 65 and older. [11]
Poverty: In North Carolina as well as nationally, older adults from most ethnic minority groups
show both a higher poverty rate and a lower life expectancy when compared with the non-Latino
white population. Poverty rates for the two largest racial groups are shown in the table below. (See
the Demographic Shift section for the information on life expectancy). [12]
58%
42%
71%
29%
0%
20%
40%
60%
80%
65+ 85+
Females Males
North Carolina Study Commission on Aging
Report to the Governor and the 2010 Session of the 2009 General Assembly 14
Table 4. Percent Below Poverty Level for the Older Population of North Carolina
by Gender, Race, and Age Group
White African American
Male Female Male Female
Age Group 65 - 74 5.3 8.5 11.3 22.1
Age Group 75+ 7.1 15.1 20.2 33.1
Source: American Community Survey (2008). Table B17001A, B17001B
Immigrants/Refugees: North Carolina has also been experiencing a rise in the immigrant
population. Many immigrants are settling in urban areas, though other rural counties are also
becoming their destination. In 2007, the State ranked 13th in the size of the foreign-born
population and ranked 15th in the number of newly admitted immigrants in 2006. Between 2000
and 2007, 282,000 immigrants arrived to the State. [13] The number of refugees arriving to the
State has also increased. About 4,292 refugees from different countries arrived between 2005 and
2007. [14] There is lack of data of exact numbers of older adults of these various immigrant
groups. Many of them face language barriers, social isolation, problems in accessing health care
and other programs/services. [15]
Residence: The 2000 Census showed that in North Carolina, 81.4 percent of householders ages
65 and older owned their homes (with or without mortgage), yet among homeowners in that age
group, over 61,000 reported incomes for 1999 that were below poverty. This figure means that
11.8 percent of the homeowners over age 65 were poor, compared to 7.5 percent for homeowners
of all age groups. [16] This has implications for both helping some older adults be responsible for
their own needs (e.g., through reverse mortgages) and for the need for property tax relief to older
adults. Among renters age 65+ who provided information, 63.2 percent, or 72,739 households,
spent more than 30 percent of their household income on rent. [17] Furthermore, 5,000 North
Carolina homeowners and renters age 65+ lacked complete plumbing facilities in their homes.
[18]
Rurality: Among all age groups, 39.8 percent of North Carolina residents live in rural areas
compared to only 21.0 percent for the country as a whole. [19] The percentage among older adults
is no doubt higher (based on the percentages of older adults in the predominantly rural counties),
but there is no age-specific figure available. In 2000, North Carolina's rural population
(3,202,238) was almost as large as Texas’s (3,647,747), the state with the largest number of rural
residents in the nation. Not only was North Carolina's rural population among the largest in terms
of numbers, but the State also reported the highest proportion (39.8 percent) of rural population
among the 20 most populous states in the nation. While 11 other states reported higher
proportions of rural population, ranging from 40.7 percent to 61.8 percent, all of these states are
much smaller in total population than North Carolina. Thus, North Carolina is unique among
more populous states in having so large a rural contingent. At the same time North Carolina has
made the transition away from an agricultural economy so that only 1.1 percent of its people live
on farms, only slightly more than the 1.0 percent for the nation as a whole. A 2002 report from
Making a Difference in Communities (MDC) highlights a long list of challenges that rural
residents and their communities face—isolation by distance, lagging infrastructure, sparse
resources that cannot adequately support education and other public services, and weak economic
competitiveness. [20]
North Carolina Study Commission on Aging
Report to the Governor and the 2010 Session of the 2009 General Assembly 15
Disability: In North Carolina, 39.8 percent of the non-institutionalized civilian population age 65
and older reported having one or more disabilities by the US Census definition—41.4 percent of
women and 37.9 percent of men, according to the 2008 American Community Survey. [21] The
Census Bureau defines disability as “a long-lasting physical, mental, or emotional condition that
makes it difficult for a person to do activities such as walking, climbing stairs, dressing, bathing,
learning, or remembering. This condition can also impede a person from being able to go outside
the home alone or to work at a job or business.” This definition is very broad and leads to
counting a number of people who, indeed, have difficulties but are able to function independently
and would not meet the average person’s perception of a person with a disability.
Health Status: Heart disease is the leading cause of death among older adults both nationwide
and in North Carolina with cancer and stroke, coming second and third on the list. [22] In
particular, the coastal plain region of North Carolina has the fourth highest stroke death rate in the
nation and is labeled by some as the Buckle of the Stroke Belt. [23] African Americans and other
racial minorities are at substantially higher risk for certain chronic conditions such as heart
disease, stroke, and diabetes (a major contributor to heart disease, stroke, and other conditions).
[24] Diabetes mellitus is the sixth leading cause of death for North Carolina’s older population in
general, but like stroke, it is a more serious threat to the African American community, being the
fourth highest cause of death in African Americans of all ages in our State. [22]
Table 5. Five Leading Causes of Death among North Carolinians Age 65+
Rank Cause
1 Heart diseases
2 Cancer
3 Cerebrovascular diseases
4 Chronic lower respiratory diseases
5 Alzheimer’s disease
Source: NC Center for Health Statistics (2009). Leading Causes of Death – 2008.
An important factor in health status is physical activity. A sedentary life-style is known to increase
a person’s risk of heart disease, diabetes, and other chronic conditions. Fortunately, more older
adults in NC have been engaging in physical activity lately. The 2008 Behavioral Risk Factor
Surveillance System (BRFSS) shows that 68.7% of older adults age 65+ have participated in
physical activities or exercise other than their regular jobs, in the past month. The survey also
shows that among people age 65+, only 19.5% said that their general health status is fair and 11.5%
as poor. [25]
According to the 2008 American Community Survey 99% of older adults 65 and over (civilian non-institutionalized)
had health insurance coverage and 70% of them had private health insurance. [26]
Grandparents Raising Grandchildren: According to the 2008 American Community Survey
there were 97,784 NC grandparents who reported that they had one or more grandchildren living
with them under 18 years old for whom they were responsible. This represents nearly half of all
grandparents whose grandchildren live with them. Some 38 percent of NC grandparents
responsible for their grandchildren are African American; 4 percent are Hispanic/Latino; 2 percent
are American Indian or Alaskan Native; and 57 percent are White. Given the relative sizes of these
populations, it is clear that this is an even larger issue in the African-American community than
North Carolina Study Commission on Aging
Report to the Governor and the 2010 Session of the 2009 General Assembly 16
among other ethnic groups. [27]
Veteran Status: Of the estimated 746,259 veterans living in NC in 2008, over 260,236, or 35
percent, were age 65 and older. [28] The group of veterans from the Vietnam era contains
proportionally more disabled members than survivors of earlier wars due to quicker and more
advanced medical treatment. The Veterans Administration has frequently written about the aging of
the veterans as a major challenge to its health care system in coming years. [29]
In summary, North Carolina has a large, economically and ethnically diverse older population.
With this diversity come both special assets and special challenges. Even the most vulnerable older
adults often give as much to their communities as they receive. Nevertheless, we must be aware that
those who face disabilities, disparities of income and health care, and the responsibilities of caring
for grandchildren are more likely to need public services and supports. While meeting these
disparate needs of today’s older adults, our State is also witnessing the first minor steps of the
transition of the baby boomers into retirement ages. This will transform the age structure of the
State and bring a new generation of older adults with some of the same historic issues, but also new
attitudes, new challenges, new opportunities, and new resources.
North Carolina Study Commission on Aging
Report to the Governor and the 2010 Session of the 2009 General Assembly 17
Sources of Information
[1] Demographic Unit, Office of State Budget and Management (2009). Population Estimates and Projections. Projected County
Totals. http://www.osbm.state.nc.us/demog/prsage.html
[2 ] NC Division of Aging and Adult Services (2009). The Aging of North Carolina: The 2003-2007 North Carolina Aging
Services Plan
[3] Charles Longino (2009). States Ranked by the Net Number of Migrants Age 60+,1985-1990 and 1995-2000
[4] Data provided by Dr.Don Bradley from East Carolina University, 2008.
http://www.ncdhhs.gov/aging/demograpic/EastCarolinaUniversity_Report_LterLifeMigrationFlows.pdf
[5] NC Center for Health Statistics (2009). Healthy Life Expectancy in North Carolina, 2005-2007.
[6] US Administration on Aging (2009). Population for States by Age Group-Rank based on number: July 1, 2008;
http://www.aoa.gov/AoARoot/Aging_Statistics/Census_Population/Population/2008/index.aspx
[7] US Administration on Aging (2008). Population for States by Age Group-Rank based on percent: July 1, 2008;
http://www.aoa.gov/AoARoot/Aging_Statistics/Census_Population/Population/2008/index.aspx
[8] Demographic Unit, Office of State Budget and Management (2009). Population Estimates and projections. County/state
projections: Age, Race and Sex Projections.
[9] Institute for Research on Women & Gender (2002). Difficult Dialogues Program Consensus Report: Aging in the Twenty-first
Century.
[10] US Census Bureau (2008). 2008 American Community Survey. Table B12002.
[11] US Administration on Aging (2009). Number of Persons 65+ by Race and Hispanic Origin-by State-2008.
http://www.aoa.gov/AoARoot/Aging_Statistics/Census_Population/Population/2008/index.aspx
[12] American Community Survey 2008. Table B17001A, B17001B
[13] Center for Immigration Studies, 2007. Immigrants in the United States, 2007: A profile of
America’s Foreign-Born Population. Center for Immigration Studies. Retrieved on Sep 16,
2008 from http://www.cis.org/immigrants_profile_2007
[14] U.S. Department of Homeland Security, Office of Immigration Statistics. Refugees and
Asylees:2007, Annual Flow Report, July 2008. Retrieved on Sep 10, 2008 from
http://www.dhs.gov/xlibrary/assets/statistics/publications/ois_rfa_fr_2007.pdf
[15] Lowman. S., Hunter, R., Reddy, S.(2008). Immigrant Elders in NC: Challenges and Opportunities. NC Medical Journal. 69
(5).
[16] US Census Bureau (2003). Census 2000 Summary File 3. Tables HCT2 and HCT24
[17] US Census Bureau (2003). Census 2000 Summary File 3. Table H71
[18] NC State Library (2003). Special tabulation from the Census 2000 data as requested by the NC Division of Aging and Adult
Services.
[19] US Census Bureau (2003). Census 2000 P5 (Summary File 3).
[20] Making a Difference in Communities in the Sought (MDC) (2002). State of the South 2002.
[21] US Census Bureau (2008). 2008 American Community Survey. Table B18001.
[22] NC State Center for Health Statistics (2009). Leading Causes of Death-2008
http://www.schs.state.nc.us/SCHS/deaths/lcd/2008/pdf/TblsA-F.pdf.
[23] Tri-State Stroke Network. (2006) Facts and Statistics: Stroke in the United States
http://www.tristatestrokenetwork.org/facts.html#buckle
[24] NGA Center for Best Practices (2004). Measuring the Years: State Aging Trends & Indicators.
[25] NC State Center for Health Statistics (2008). Behavioral Risk Factor Surveillance Calendar Year 2008 Results. Exercise;
Health Status; http://www.schs.state.nc.us/SCHS/
[26] US Census Bureau (2008). 2008 American Community Survey. Table B18001.
[27] US Census Bureau (2008). 2008 American Community Survey. Table B10051, B10051A-I
[28] US Census Bureau (2008). 2008 American Community Survey. Table B21001.
[29] US Department of Veterans’ Affairs (2002) VA History in Brief http://webpages.charter.net/wisconsinlegion-
7thdistrict/VA_History.htm#Vietnam_War
Pertinent Web Sites for Related Information
 NC Division of Aging and Adult Services (http://www.dhhs.state.nc.us/aging/demo.htm)
 Demographics Unit, NC Office of Budget and Management (http://demog.state.nc.us/)
 NC State Center for Health Statistics (http://www.schs.state.nc.us/SCHS/)
 US Census Bureau (http://www.census.gov)
North Carolina Study Commission on Aging
Report to the Governor and the 2010 Session of the 2009 General Assembly 18
COMMISSION PROCEEDINGS
January 7, 2010
The North Carolina Study Commission on Aging met on Thursday, January 7, 2010, at 10:00 a.m.
in Room 544 of the Legislative Office Building. Senator A.B. Swindell presided. Following
introductions, Theresa Matula, Commission staff, provided an overview of older adults in North
Carolina. Her presentation focused on: who they are, how many there are, where they live, and what
types of programs and services are available for older adults in North Carolina. The presentation
included data on changes in the North Carolina population which depict the probability of
significant growth in the older adult population. The presentation included a brief summary of the
range of services provided in the State which include: Senior Games, Senior Centers, Adult Day
Care and Adult Day Health Care, State/County Special Assistance, the State/County Special
Assistance In-Home Program, the services provided by Home and Community Care Block Grant
funds, the Community Alternatives Program for Disabled Adults (CAP/DA), assisted living,
Multiunit Assisted Housing with Services, Adult Care Homes, Nursing Homes, Continuing Care
Retirement Communities, and Medicare/Medicaid. Ms. Matula ended her presentation by
mentioning additional information and resources including the Area Agencies on Aging and various
divisions within the Department of Health and Human Services that serve older adults.
Shawn Parker, Commission staff, then presented a document containing summaries of substantive
legislation related to older adults that was enacted during the 2009 Session. Mr. Parker was
followed by Melanie Bush, Commission staff, who provided an overview of 2009-2011 legislative
budget actions and special provisions. Sara Kamprath, Commission staff, presented an overview of
the Commission's responsibilities and statutory authority. Next the Commission heard from Shawn
Parker, Commission staff, who presented a status report of the Study Commission on Aging's
recommendations to the Governor and the 2009 General Assembly. The last presentation was the
tentative meeting schedule for the interim, and the Commission's budget which was approved.
For a period of time, the agenda and handouts for this meeting are available on the internet at:
http://www.ncleg.net/gascripts/DocumentSites/browseDocSite.asp?nID=38. (Look under 2009-10
Interim Commission Meetings.) Minutes for each meeting are on file in the Legislative Library.
January 21, 2010
The North Carolina Study Commission on Aging met Thursday, January, 21, 2010, at 10 a.m. in
Room 544 of the Legislative Office Building. Representative Jean Farmer-Butterfield presided.
Presentation topics included: aging services and programs, an overview of the adult care home star
rating program, and the expansion of the star rating program.
Dennis Streets, Director, Division of Aging and Adult Services, Department of Health and Human
Services (DHHS), discussed the State resources available for older adults, funding sources for
services, and concerns regarding the present system of services. Mr. Streets listed a few concerns
the Division has in relation to service needs. They are:
 Increase in Adult Protective Services Reports
 Growth of the Wait List for Home and Community Services
 Status of Home and Community Care Block Grant
 Increase in Public Guardianship Cases
 Uncertainty Within Alzheimer’s Support Network
 The NC Roadmap
North Carolina Study Commission on Aging
Report to the Governor and the 2010 Session of the 2009 General Assembly 19
Mr. Streets then presented reasons to remain optimistic through examples of volunteers, workers,
and individuals that provided extraordinary care to North Carolina's aging population.
Next Megan Lamphere, Facility Survey Consultant, Adult Care Licensure Section, Division of
Health Service Regulation (DHSR), DHHS, presented a report in response to S.L. 2007-544,
Section 3(g) on the Adult Care Home Star Rated Certificate Program. This program was initiated
by the Commission in response to citizens of North Carolina who voiced the need for increased
availability of public information regarding the care provided in adult care facilities. The North
Carolina Medical Care Commission developed rules for the rating program with input from
residents and families in adult care homes, advocacy groups, providers and others.
The last presentation was given by Jeff Horton, Acting Director, Division of Health Service
Regulation, DHHS. Mr. Horton discussed the expansion of the Star Rated Certificate Program in
response to S.L. 2007-544, Section 3(f). The Division identified the following four categories of
other facilities (non-adult care homes) and services licensed and certified by DHHS to be
considered for inclusion in a rated certificate program:
 Acute and home care facilities and agencies,
 Nursing homes,
 Mental health, developmental disabilities and substance abuse services, and
 Adult day services.
Mr. Horton informed the Commission that the Centers for Medicare and Medicaid Services (CMS)
provides quality information on their website for nursing homes and hospitals. Mr. Horton stated
that although home care agencies are required to be inspected every three years, the Division does
not currently have sufficient staff to conduct the inspections every three years. With regard to
Mental Health, Developmental Disabilities and Substance Abuse Services facilities, Mr. Horton
indicated that making inspection information available would not require changes to the statutes or
the rules, but would require additional personnel. For adult day services, significant challenges to
the creation of an effective rated certificate system exist and it was concluded that the cost
outweighs the benefit at this time.
For a period of time, the agenda and handouts for this meeting are available on the internet at:
http://www.ncleg.net/gascripts/DocumentSites/browseDocSite.asp?nID=38. (Look under 2009-10
Interim Commission Meetings.) Minutes for each meeting are on file in the Legislative Library.
February 4, 2010
The North Carolina Study Commission on Aging met on Thursday, February 4, 2010, at 10:00 a.m.
in Room 544 of the Legislative Office Building. Senator A.B. Swindell was the presiding Co-
Chair. The meeting was devoted to three issues impacting older adults: hearing loss, Medicaid
changes, and adult day care sustainability.
Ms. Jan Withers, Director of the Division of Services for the Deaf and Hard of Hearing (DSDHH),
Department of Health and Human Services (DHHS), briefed the Commission on the impact of
hearing loss in older adults in North Carolina. She reported on the results of the study undertaken
as a result of S.L. 2008-181, Sec. 12.1. During her presentation, Ms. Withers reviewed significant
aspects of the report and presented the following three recommendations to the Commission:
 Establish a task force to assess the feasibility of developing and implementing a formal
system that optimizes consumer capacity to fully evaluate quality of hearing aid services
prior to and during the process of purchasing hearing aids.
 Enact legislation that would require all hearing aid dispensers to provide a minimum 30-day
trial period with a money back guarantee and instructions on the function of the telecoil and
North Carolina Study Commission on Aging
Report to the Governor and the 2010 Session of the 2009 General Assembly 20
its use.
 Consider legislation requiring hearing aid health insurance coverage for all ages from any
private agency providing health insurance and doing business in North Carolina and from
any public agency providing medical insurance coverage assistance.
Next, Dr. Larry Nason and Dr. Karen Feasel, from the Division of Medical Assistance, DHHS, gave
a presentation on Medicaid changes and the impact on older adults. Dr. Nason gave a basic
overview of the Medicaid Personal Care Services (PCS) Program and the scope of authorized
services under the program. He highlighted differences between PCS provided under a 1915(c)
Waiver versus PCS provided as an optional service under the State Medicaid Plan; discussed the
dramatic and steady increase in PCS participation, utilization and costs; and reviewed the General
Assembly’s budget reduction goals for PCS for State fiscal years 2009-2010 and 2010-2011. Dr.
Feasel provided information on the PCS compliance reviews conducted by The Carolinas Center for
Medical Excellence and reported on eight specific actions planned by DMA. These actions are an
effort to implement changes to the PCS benefit that are mandated by Session Law 2009-451 to
achieve budgeted reductions. Dr. Feasel also reviewed the history of the CAP/DA slot allocations
and explained the pending reduction in PCS slot allocations under this program.
Lastly, Ms. Teresa Johnson from the North Carolina Adult Day Services Association presented a
five year post study follow-up on adult day care sustainability. She reviewed various
reimbursement methodology changes, as well as training and technical assistance initiatives
implemented at the recommendation of a national adult day services resource center under contract
with DHHS. Ms. Johnson concluded that these changes have made our adult day centers healthier
and established North Carolina as a leader in the adult day services industry.
For a period of time, the agenda and handouts for this meeting are available on the internet at:
http://www.ncleg.net/gascripts/DocumentSites/browseDocSite.asp?nID=38. (Look under 2009-10
Interim Commission Meetings.) Minutes for each meeting are on file in the Legislative Library.
February 25, 2010
The North Carolina Study Commission on Aging met on Thursday, February 25, 2010 at 10:00 a.m.
in Room 544 of the Legislative Office Building. Representative Farmer-Butterfield was the
presiding Co-Chair. The Commission members heard presentations on nurse aide preparation and
older driver safety.
Jesse Goodman, Acting Chief Operating Officer, Division of Health Service Regulation, DHHS
presented information on types of aides, current requirements, locations of employment, and other
related information. His presentation included: the federally defined definition of a nurse aide, the
State and federal requirements for Nurse Aide I registry listing, the federally required content for
Nurse Aide I Training Programs, information on State approved training programs, federal
requirements for competency evaluation, passing rates by test taker groupings, supply and demand
for nurse aides, and the typical duties of a nurse aide. According to Mr. Goodman, in 2006, there
were 72,130 Home Health Aides employed, 21,780 Nurse Aides, and 18,350 Personal and Home
Care Aides. Over the next ten years, the demand for aides employed in each of these three
categories is anticipated to increase as follows: 30% for Nurse Aides, 39% for Home Health Aides,
and 76% for Personal and Home Care Aides. Mr. Goodman also provided the following
breakdown by employment setting for Nurse Aides:
 Home Health/Home Care - 24%
 Private Duty, Military/VA, Schools, Adult Day Care, Rehab, Native American Reservations – 21%
 Nursing Homes – 20%
 Hospital/Hospice/Mental Health – 15%
 Not Employed in Health Care – 10%
North Carolina Study Commission on Aging
Report to the Governor and the 2010 Session of the 2009 General Assembly 21
 Adult/Family Care Home – 6%
 Clinics – 3%
During this meeting the Commission also heard presentations from the following: Saundra
Spillman, Executive Director, Direct Care Workers Association of NC; Linda Burhans, Director
Education/Practice, NC Board of Nursing, and LeRoy King and Elizabeth Todd Beal, Friends of
Residents in Long-Term Care. Dr. Spillman presented information on the benefits of a career
lattice approach and on the Direct Care Workers Association's collaborative efforts to provide a
conference aimed at reducing turnover and increasing job satisfaction. Dr. Burhans, NC Board of
Nursing, presented information on Medication Aide qualifications, tasks, and education programs,
and on the qualifications, task lists, education programs, and employment settings for the Nurse
Aide II. Dr. King and Ms. Beal provided the Commission with federal regulations for training
programs and information showing that more than half of the states have training requirements that
exceed the federal regulations.
Information on older drivers was presented by David Harkey, Executive Director, UNC Highway
Safety Research Center; Susan Stewart, Medical Evaluation Program, NC Division of Motor
Vehicles; and Phyllis Bridgeman, Cochair of the Older Drivers Task Force. Mr. Harkey provided
national and State demographic and safety data for older drivers as well as aging driver safety
strategies. Mr. Harkey reported that older driver safety is trending in a positive direction and that
in-person renewal correlates to a reduction in fatality rates for older drivers. Ms. Stewart reported
that the Driver Medical Evaluation program, in the Division of Motor Vehicles (DMV), is
administered with medical counsel and individual case recommendations provided by physicians
and physician extenders. Ms. Stewart also reported that drivers are referred to the DMV by
concerned physicians, family members, drivers license examiners, and law enforcement officers.
Ms. Bridgeman presented recommendations from the Older Drivers Task Force which included:
improved signage at non-standard intersections; building capacity to accommodate the needs of
older drivers; strengthening DMV training to identify drivers at increased risk of crashing;
increasing public awareness of older driver issues and resources; engaging law enforcement in
implementing older driver safety initiatives; and implementing older driver safety initiatives by
engaging physicians and other health care providers.
For a period of time, the agenda and handouts for this meeting are available on the internet at:
http://www.ncleg.net/gascripts/DocumentSites/browseDocSite.asp?nID=38. (Look under 2009-10
Interim Commission Meetings.) Minutes for each meeting are on file in the Legislative Library.
March 4, 2010
The North Carolina Study Commission on Aging met on Thursday, March 4, 2010, at 10 a.m. in
Room 544 of the Legislative Office Building. Senator A.B. Swindell presided.
Carla Obiol with the North Carolina Seniors' Health Insurance Information Program (SHIIP),
Department of Insurance, presented a report required by S.L. 2006-66, Section 10.10 on the
development of the North Carolina Long-Term Care Partnership (LTCP) program. Ms. Obiol
explained that the number one reason for establishing a LTCP program is the increase in the number
of baby boomers seeking long-term care and the potential for the long-term care needs of baby
boomers to overwhelm Medicaid's pay-as-you-go financing. The LTCP program is a public-private
program between state Medicaid agencies and private insurers that is designed to encourage
the purchase of long-term care insurance. The LTCP program is aimed at middle- and upper-income
individuals who want to protect their assets while allowing access to long-term care benefits
through the state Medicaid program. Policy holders who exhaust their private coverage but still
need long-term care benefits can access Medicaid without the usual spend down routes.
North Carolina Study Commission on Aging
Report to the Governor and the 2010 Session of the 2009 General Assembly 22
Both the North Carolina Department of Insurance and the North Carolina Division of Medical
Assistance, DHHS support the establishment of a LTCP program in North Carolina. Carolyn
McClanahan, Division of Medical Assistance, Department of Health and Human Services,
explained that the amount of benefits used on the long-term care policy will not be counted in
determining Medicaid eligibility. She also mentioned that other states who have recently
implemented an LTCP program have reported no fiscal impact so no fiscal impact is expected for
Medicaid in North Carolina.
Next the Commission heard a report required by S.L. 2009-100 that directed the Department of
Health and Human Services, Division of Public Health, DHHS, in collaboration with the Division
of Medical Assistance, the Division of Aging and Adult Services, the University of North Carolina-
Chapel Hill (UNC-CH) and the East Carolina University (ECU) Schools of Dentistry, the North
Carolina Dental Society, and providers of special care dentistry services, to examine the current
dental care options for populations that require special care dentistry services and suggest ways to
improve the availability of those dental services.
Dr. Kevin Buchholtz, Oral Health Section, Division of Public Health, DHHS and Dr. Bill Milner,
Access Dental Care, highlighted several recommendations from the report, Special Care Oral
Health Services: A north Carolina Commitment. The report and the presentation define patients
with special needs, existing dental care options, consumer issues, provider/payer issues, systems
issues, and a vision to address the gaps. The report contains a total of 16 recommendations, many
of which were highlighted during the presentation. Due to the number of recommendations and the
economic challenges faced by the State, the Commission requested a prioritized list of
recommendations. This list was provided to the Co-Chairs and staff following the meeting and
contained six recommendations that did not require funding and three recommendations that do
require funding.
 Direct the Division of Health Service Regulation to collaborate with the Division of Public
Health, NC Board of Nursing, National Association of Directors of Nursing Administration,
NC Health Care Facilities Association, NC Non-Profit Nursing Home Association, UNC
School of Public Health, Friends of Residents of Long-Term Care, NC Ombudsman
Association, and special care dental providers to determine the current status of daily oral
hygiene conditions in long-term care residents, existing effective programs, health and
financial issues related to systemic infection, facilities issues related to program
implementation and make recommendations.
 Appoint a dentist to the Commission on Children with Special Health Care Needs.
 Support the NC Commission on Children with Special Health Care Needs' Oral Health
Work Group, NC Family Council for Children and Youth with Special Health Care Needs,
Family Voices, the NC Council on Developmental Disabilities, and the NC Office on
Disability and Health to develop a central point of communication for families with
intellectual or developmental disabilities and oral health issues.
 Direct NC AHEC, UNC-CH and ECU Schools of Dentistry, NC Community College
system, and current special care dental providers to create a plan of action to produce the
necessary workforce manpower to care for NC special care populations.
�� Direct the NC State Board of Dental Examiners to investigate changing existing laws to
allow dental, dental hygiene, and assisting students to receive training in long-term care
facilities under the direction of non-profit special care dental organizations.
 Direct the Division of Mental Health, Developmental Disabilities and Substance Abuse
Services to develop a business plan to provide in-house and community dental services at
each of its psychiatric hospitals, developmental and neuron-medical centers.
 Maintain Medicaid dental services for adults and consider expanding the services to include
North Carolina Study Commission on Aging
Report to the Governor and the 2010 Session of the 2009 General Assembly 23
reimbursement for evidenced-based chemotherapeutic agents (fluoride therapies, periodontal
therapies, etc.) for high-risk adults with special health care needs.
 Direct the Division of Medical Assistance to implement the facility code (CDT code D9410)
policies to allow certified providers to bill for each patient seen on a date of service in a
nursing home, group home, or other long-term care facility.
 Fund an additional mobile dental program that provides onsite comprehensive dental care
for residents in nursing homes, group homes, assisted living centers, adult day health care
centers, and to certain individuals with special health care needs in the community.
For a period of time, the agenda and handouts for this meeting are available on the internet at:
http://www.ncleg.net/gascripts/DocumentSites/browseDocSite.asp?nID=38. (Look under 2009-10
Interim Commission Meetings.) Minutes for each meeting are on file in the Legislative Library.
March 24, 2010
The North Carolina Study Commission on Aging conducted a public hearing on March 24, 2010, at
10:00 a.m. in the town hall in Jamestown, North Carolina. Senator Swindell presided over the
public hearing. At this hearing, the Commission heard from thirty-five (35) speakers. Issues
mentioned most frequently at this hearing were: Maintain/Increase Home and Community Grant
(HCCBG) Funding, Maintain/Increase Funding for Project C.A.R.E., Maintain/Increase Funding
and Support for Adult Day Care, and Maintain/Increase Funding for New and Existing Special Care
Dental Programs. Appendix A contains a frequency distribution of the public hearing comments.
April 1, 2010
The North Carolina Study Commission on Aging met on Thursday, April 1, 2010, at 10:00 a.m. in
Room 544 of the Legislative Office Building. Representative Jean Farmer-Butterfield presided.
Dennis Streets, Director of the Division of Aging and Adult Services (DAAS), DHHS, presented an
interim report on Preparing for Older Adults, consistent with S.L. 2009-407, Section 2. The report
highlighted the ways DAAS and the University of North Carolina Institute on Aging (IOA) are
working together to help the state prepare for the aging of the baby boomer population and the
growing number of in-migrating retirees. Progress includes significant collaboration between
DAAS and IOA since August 2009; working closing with the Governor's Office and Governor's
Advisory Council on Aging, to outline roles and tasks; conversations with various stakeholders
from the UNC School of Government, directors of the state's 17 Area Agencies on Aging, and staff
of the North Carolina Association of County Commissioners; construction of a survey instrument to
assess the level of awareness and preparation for North Carolina's aging population across state
government agencies; the planning of six regional roundtables, in coordination with the Governor's
Office, area agencies on aging, local providers and others, to discuss major issues and best
practices; and a web-based survey of local home and community service providers.
Mr. Streets also announced the Governor's Executive Order No. 54, Assessment of the State's
Readiness for Aging Population, which supports the regional roundtables; presented a summary of
the Haywood Community Connections toolkit designed to increase knowledge of county resources,
increase volunteerism, and provide local resources and supportive services; presented a draft
amendment to General Statute 143B-181.3 to help North Carolina pursue state and federal funding
for long-term care, and announced that North Carolina received $1 million in federal Living
Healthy Program funds. He also reminded the members of the Commission that DAAS does not
receive the results of criminal background checks of adult day care employers or employees, and
asked the Commission to consider making changes to this policy.
North Carolina Study Commission on Aging
Report to the Governor and the 2010 Session of the 2009 General Assembly 24
Next, Theresa Matula, Commission staff, presented draft recommendations for the Commission's
consideration. The draft recommendations represented a range of issues presented to the
Commission during the interim. Ms. Matula presented 11 recommendations with background
information for each and explained that once the Commission approved recommendations, they
would be compiled in a report, including bill drafts as applicable, for the 2010 General Assembly.
During the meeting, the Commission unanimously approved the 11 recommendations.
For a period of time, the agenda and handouts for this meeting are available on the internet at:
http://www.ncleg.net/gascripts/DocumentSites/browseDocSite.asp?nID=38. (Look under 2009-10
Interim Commission Meetings.) Minutes for each meeting are on file in the Legislative Library.
April 22, 2010
The North Carolina Study Commission on Aging conducted a second public hearing on April 22,
2010 at 1:00 p.m. at the Tyvola Senior Center, Charlotte, North Carolina. Representative England
presided over the public hearing and the Commission heard from twenty-five (25) speakers. The
two issues mentioned most frequently at this hearing were: Maintain/Increase Funding for Project
C.A.R.E. and Maintain/Increase HCCBG Funding. Appendix A contains a frequency distribution
of the public hearing comments.
May 11, 2010
The North Carolina Study Commission on Aging met on Tuesday, May 11 at 10:00 a.m. in Room
544 of the Legislative Office Building. Senator Swindell was the presiding Co-Chair. During the
meeting, Ms. Susan Barham, Commission staff, presented an overview of the items mentioned most
frequently during the two public hearings. Commission staff also reviewed the Commission's draft
report to the Governor and the 2010 Regular Session of the 2009 General Assembly.
For a period of time, the agenda and handouts for this meeting are available on the internet at:
http://www.ncleg.net/gascripts/DocumentSites/browseDocSite.asp?nID=38. (Look under 2009-10
Interim Commission Meetings.) Minutes for each meeting are on file in the Legislative Library.
North Carolina Study Commission on Aging
Report to the Governor and the 2010 Session of the 2009 General Assembly 25
COMMISSION RECOMMENDATIONS
The North Carolina Study Commission on Aging makes the recommendations presented in this
report to the Governor and the 2010 Session of the 2009 General Assembly. Each recommendation
is followed by background information and any corresponding legislative proposals appear in
Appendix B of this report.
Recommendation 1: Maintain HCCBG Funding
The Study Commission on Aging recommends the General Assembly and the Governor
maintain funding levels appropriated for FY 2010-2011 to the Department of Health and
Human Services for the Home and Community Care Block Grant (HCCBG).
Background 1: Maintain HCCBG Funding
During the meeting on January 21, 2010, the Commission heard a presentation from Dennis
Streets, Director, Division of Aging and Adult Services, DHHS, on the status of Aging
Services and Programs. Mr. Streets mentioned that the service system is stressed as service
needs grow. One of the areas mentioned was the growth of the wait list for home and
community services. With regard to home and community services, Mr. Streets pointed out
the following:
 Access to and intensity of services has weakened
 Service needs and wait lists are substantial
 Providers are frugal, stressed, conscientious, and innovative
 Clients are becoming more vulnerable.
 Mr. Streets provided the following status on the Home and Community Care Block
Grant (HCCBG):
 Overall funding has increased about 20% over the past 10 years – taking into account
non-recurring reductions for SFY 2009-10.
 The Statewide utilization/expenditure rate remains very high – 99.8% in SFY 2008-09.
 Service costs have increased.
 There was a decrease in the number of clients served (6.9%) and in total service units
(14.1%) between July 1, 2000 and June 30, 2009. During this period, the NC
population age 60+ and 75+ grew by 29% and 18%.
The HCCBG, established by G.S.143B-181.1(a)(11), includes federal funds, State funds, local
funds, and a consumer contribution component. It gives counties discretion, flexibility, and
authority in determining services, service levels, and service providers; and streamlines and
simplifies the administration of services. The focus of the HCCBG is to support the frail
elderly that are cared for at home; improve and maintain the physical and mental health of
older adults; assist older adults and their caregivers with accessing services and information;
provide relief to family caregivers so that they can continue their caregiving; and allow older
adults to remain actively engaged with their communities.
With input from older adults, County Commissioners approve an annual funding plan that
defines services to be provided, the funding levels for these services, and the community
service agencies to provide these services. Counties can select from among 18 eligible
services including: Adult Day Care, Adult Day Health Care, Care Management, Congregate
Nutrition, Group Respite, Health Promotion and Disease Prevention, Health Screening, Home
Delivered Meals, Housing and Home Improvement, Information and Assistance, In-Home
Aide, Institutional Respite Care, Mental Health Counseling, Senior Center Operations, Senior
North Carolina Study Commission on Aging
Report to the Governor and the 2010 Session of the 2009 General Assembly 26
Companion, Skilled Home (Health) Care, Transportation, and Volunteer Program
Development. Counties decide which services to provide, however congregate nutrition and
home-delivered meals are provided in almost every county under the HCCBG.
The Study Commission on Aging recommends that the General Assembly and the Governor
maintain funding levels appropriated for FY 2010-2011 for the Home and Community Care
Block Grant (HCCBG). The Governor's Advisory Council on Aging and the Senior Tar Heel
Legislature both support funding for the HCCBG. Maintain and increase HCCBG funds was
also one of the most frequently mentioned issues during the public hearings conducted during
March and April.
Recommendation 2: Maintain Funding for Senior Centers, Project C.A.R.E., and Other
Vital Support Programs and Services
The Study Commission on Aging recommends the General Assembly and the Governor
maintain current funding levels for senior centers and Project C.A.R.E. as well as many other
vital programs that provide aging services and support systems for older adults and their
families.
Background 2: Maintain Funding for Senior Centers, Project C.A.R.E., and Other Vital
Support Programs and Services
During the January 21, 2010 meeting, the Commission heard a presentation from Dennis
Streets, Director, Division of Aging and Adult Services, DHHS. During this presentation Mr.
Streets shared information on items that are essential to future systems for aging services and
supports. His points were as follows:
 Easy and reliable access to information and assistance to facilitate personal
responsibility.
o Efforts include: North Carolina's "No Wrong Door" approach, nccarelink.gov,
senior centers, and Community Resource Connections for aging and
disabilities.
 Effective holistic and collaborative management of chronic conditions.
o Efforts include: Community Care Connections, Programs of All-Inclusive Care
for the Elderly (PACE), person-centered and consumer-directed approaches to
chronic care, pursuing a stronger connection with the Veterans Administration,
following the NC Roadmap for Healthy Aging, and falls prevention programs.
 Timely protection and intervention for vulnerable individuals.
o Efforts include: adult protective services reform, the Institute of Medicine Task
Force on co-locating different populations in adult care homes, Relay for Extra
Help, and Project C.A.R.E. (Caregiver Alternatives to Running on Empty).
(Project C.A.R.E. provides the following assistance to caregivers of people
with dementia: in-home needs assessments; counseling; information; assistance
finding and selecting respite; funds for in-home personal care, adult day
services, and respite; training and educational resources; and connections with
Area Agencies on Aging and Alzheimer's Association Chapters.)
 An awareness that successful aging involves more than health and human services.
o Efforts include: Enactment of S.L. 2009-407 (SB 195) Preparations for Aging
Baby Boomers, strengthening the Governor's Advisory Council on Aging,
North Carolina Study Commission on Aging
Report to the Governor and the 2010 Session of the 2009 General Assembly 27
aging video on careers in aging services, NC Center for Public Policy Research,
NC Complete Count (2010 Census), and 2011 Reauthorization of the Older
Americans Act.
The Study Commission on Aging recommends that the General Assembly and the Governor
maintain current funding levels for senior centers, Project C.A.R.E., and other vital programs
that provide aging services and support systems for older adults and their families. The
Governor's Advisory Council on Aging and the Senior Tar Heel Legislature both support
funding for the Project C.A.R.E. and Senior Centers. Additionally, maintain and increase
funds for Project C.A.R.E. was one of the most frequently mentioned items during the two
public hearings.
Recommendation 3: Hearing Loss Treatment Task Force
The Study Commission on Aging recommends the General Assembly direct the Hearing Aid
Dealers and Fitters Board to coordinate a task force including representatives of the Division
of Services for the Deaf and Hard of Hearing in the Department of Health and Human
Services, the Consumer Protection Division of the Office of Attorney General, and other
interested stakeholders, to: 1) develop recommended guidelines for consumers seeking
assistance in the treatment of hearing loss, 2) make recommendations on the best way to
disseminate these guidelines, and 3) report to the Study Commission on Aging on or before
October 15, 2010.
Background 3: Hearing Loss Treatment Task Force
S.L. 2008-181, Sec. 12.1, directed the Department of Health and Human Services (DHHS) to
study the impact of hearing loss on North Carolina's older adult population and to report to the
Commission.
On February 4, 2010, Jane Withers, Director, Division of Services for the Deaf and Hard of
Hearing, DHHS presented a report to the Commission. The report pointed out that, "Hearing
loss in an older adult tends to happen gradually and is not always identified, and less often
treated." The report points out that while hearing aids are one of the most effective treatments,
they range in price from $1,400 to $5,000 and that they are not normally covered by health
insurance. Based on the study, the Division of Services to the Deaf and Hard of Hearing,
DHHS, recommended: establishing a task force to assess the feasibility of developing and
implementing a system to evaluate hearing aid services; requiring all hearing aid dispensers
provide a 30-day trial period; and asking the General Assembly to require health insurance
providers to cover hearing aids.
With regard to trial periods, the report provided the following:
"The Federal Trade Commission which monitors the business practices of hearing aid
dispensers allows trial period mandates to be determined by each state. In the State
of North Carolina, there is not a 30-day trial period mandated. Most dispensers in the
state do provide a minimum 30-day trial period as a gesture of good customer service
though no law requires them to do so."
While the current economic climate would make required health insurance coverage of
hearing aids a challenge for the State and for many employers, the Commission does
recognize the importance of hearing aid availability, proper fit, and consumer education. As
such the Commission believes that the most feasible option at this time is to direct the Hearing
Aid Dealers and Fitters Board to coordinate a task force that will develop recommended
guidelines for consumers seeking assistance in the treatment of hearing loss, to make
recommendations on the best way to disseminate the guidelines, and to report to the NC Study
North Carolina Study Commission on Aging
Report to the Governor and the 2010 Session of the 2009 General Assembly 28
Commission on Aging. The task force should include representatives from the Division of
Services for the Deaf and Hard of Hearing (DHHS), the Consumer Protection Division of the
Office of Attorney General, and other interested stakeholders. Therefore, the Commission
recommends the General Assembly enact 2009-SHz-20.
Recommendation 4: Review of Nurse Aide Training Requirements
The Study Commission on Aging recommends the General Assembly direct the Division of
Health Service Regulation, Department of Health and Human Services (DHHS), to coordinate
a review involving an equal number of representatives from the Division of Aging and Adult
Services, DHHS; the NC Board of Nursing; the Direct Care Workers Association; NC Health
Care Facilities Association; NC Hospital Association; NC Home and Hospice Care
Association; and representatives of residents in long-term care; to assess the current training
requirements for nurse aides and to recommend any necessary changes to the Study
Commission on Aging on or before November 1, 2010.
Recommendation 4: Review of Nurse Aide Training Requirements
On February 25, 2010, the Commission heard a presentation by the Division of Health Service
Regulation on types of aides, current requirements, locations of employment, and other related
information. The Division presented the following information: federally defined definition of
a nurse aide, the State and federal requirements for Nurse Aide I registry listing, the federally
required content for Nurse Aide I Training Programs, information on State approved training
programs, federal requirements for competency evaluation, passing rates by test taker
groupings, supply and demand for nurse aides, and the typical duties of a nurse aide.
According to the Division of Health Service Regulation, the majority of Home Health Aides,
Personal and Home Care Aides, are also Nurse Aides. In 2006, there were 72,130 Home
Health Aides employed, 21,780 Nurse Aides, and 18,350 Personal and Home Care Aides.
Over the next ten years, the demand for aides employed in each of these three categories is
anticipated to increase: 30% for Nurse Aides, 39% for Home Health Aides, and 76% for
Personal and Home Care Aides.
The Division also reported the following Nurse Aide I employment breakdown by
employment setting:
 Home Health/Home Care - 24%
 Private Duty, Military/VA, Schools, Adult Day Care, Rehab, Native American
Reservations – 21%
 Nursing Homes – 20%
 Hospital/Hospice/Mental Health – 15%
 Not Employed in Health Care – 10%
 Adult/Family Care Home – 6%
 Clinics – 3%
During the February meeting, the Commission also heard presentations from representatives
of the Direct Care Workers Association of NC, NC Board of Nursing, and Friends of
Residents in Long-Term Care.
 The Direct Care Workers Association presented information on their Association,
collaborative efforts to provide a conference aimed at reducing turnover and increasing
job satisfaction, and the benefits of a career lattice approach.
 The NC Board of Nursing presented the following information on the Nurse Aide II:
qualifications, task lists, education programs, and employment settings. In addition
North Carolina Study Commission on Aging
Report to the Governor and the 2010 Session of the 2009 General Assembly 29
they presented information on Medication Aide qualifications, tasks, and education
programs.
 Representatives from Friends of Residents in Long-Term Care presented information
on federal regulations for training programs, information that more than half of the
states have training requirements that exceed the federal regulations, and the citations
for nurse aide training requirements for all 50 states and the District of Columbia.
The Study Commission on Aging recognizes the importance of nurse aides, the care they
provide, and the anticipated labor market shortages. The Commission recommends a review
of the current training requirements for nurse aides and requests recommendations on the
appropriateness of training requirements. The review should be coordinated by the Division
of Health Service Regulation, (DHHS), and should include an equal number of representatives
from the Division of Aging and Adult Services, DHHS; the NC Board of Nursing; the Direct
Care Workers Association; NC Health Care Facilities Association; NC Hospital Association;
NC Home and Hospice Care Association; and representatives of residents in long-term care.
The Commission urges the General Assembly to enact 2009-SHz-21.
Recommendation 5: Long-Term Care Partnership Program
The Study Commission on Aging recommends the General Assembly enact legislation to
develop a Long-Term Care Partnership (LTCP) program for North Carolina and direct the
Division of Medical Assistance, Department of Health and Human Services, to pursue a State
Plan amendment allowing the operation of the LTCP program.
Background 5: Long-Term Care Partnership Program
S.L. 2006-66, Sec. 10.10, directed the Department of Health and Human Services (DHHS) to
develop a North Carolina Long-Term Care Partnership Program. The program was to be
developed in accordance with section 1917(b) of the Social Security Act (42 USC §
1396p(c)), as amended by Public Law 109-171 effective January 1, 2007. The purpose of the
program is to reduce future Medicaid costs for long-term care by delaying or eliminating
dependence on Medicaid. The goal of the program is to offer incentives to individuals to
ensure against the substantial costs of providing for their long-term care needs. DHHS was
required to submit a report to the General Assembly.
During the meeting on March 4, 2010, the Commission heard a presentation on a Long-Term
Care Partnership (LTCP) program in North Carolina provided by representatives of the
Seniors' Health Insurance Information Program (SHIIP), located in the Department of
Insurance, and the Division of Medical Assistance, in the Department of Health and Human
Services. The presentation explained that a LTCP program allows a special resource
disregard and resource protection at Estate Recovery for an individual who: 1) purchases a
LTCP policy, 2) utilizes the benefits of the policy, and 3) applies for Medicaid. The amount
of resource disregard and the Estate Recovery resource protection is equal to the amount of
benefits paid out by the LTCP policy prior to the application for Medicaid. The presentation
and the report covered: 1) requirements of long-term care partnership, 2) policy disclosure
requirements, 3) agent training, 4) data collection, 5) consumer protection, 6) fiscal impact,
and 7) recommendations.
The Department of Insurance and the Department of Health and Human Services requested
the Commission recommend establishment of a Long-Term Care Partnership program in
North Carolina to the General Assembly. The report and subsequent conversations with the
Department of Health and Human Services have indicated no anticipated fiscal impact.
The Study Commission on Aging believes that it is in the best interest of the State and its
North Carolina Study Commission on Aging
Report to the Governor and the 2010 Session of the 2009 General Assembly 30
citizens to encourage personal responsibility and planning for long-term care. As such, the
Study Commission on Aging recommends the General Assembly enact legislation to develop
a Long-Term Care Partnership program and direct the Division of Medical Assistance,
Department of Health and Human Services, to pursue a State Plan amendment allowing the
operation of the LTCP program. As such, the Commission recommends enactment of 2009-
SHz-25.
Recommendations 6, 7, 8 and 9
Recommendation 6: Include Dentist on the Commission on Children with Special Health
Care Needs
The Study Commission on Aging recommends the General Assembly expand the membership
of the Commission on Children with Special Health Care Needs to include a dentist.
Recommendation 7: Special Needs Dental Care Workforce Development
The Study Commission on Aging recommends the General Assembly direct the North
Carolina Area Health Education Centers (AHEC) Program to: 1) work with the dental schools
at The University of North Carolina – Chapel Hill and East Carolina University, the North
Carolina Community College System, and current special care dental providers to increase the
available workforce willing to treat North Carolina special care populations; 2) work with the
NC State Board of Dental Examiners to explore the feasibility of allowing dental students,
dental hygiene students, and assisting students the opportunity to receive training in long-term
care facilities under the direction of non-profit special care dental organizations; and 3) report
to the Study Commission on Aging on or before August 1, 2011.
Recommendation 8: Medicaid Dental Services
The Study Commission on Aging recommends the General Assembly maintain Medicaid
funding for dental services and direct the Division of Medical Assistance and the Division of
Public Health to: 1) explore the feasibility of expanding Medicaid dental services to include
reimbursement for evidenced-based fluoride and periodontal therapies for high risk adults
with special health care needs, 2) explore the implementation of facility code policies that
would allow certified providers to bill for each patient seen in a long-term care facility or
group home on the date of service, and 3) report on or before November 15, 2011 to the Study
Commission on Aging.
Recommendation 9: Additional Mobile Dental Units
The Study Commission on Aging recommends the Department of Health and Human Services
and the special care mobile dental providers explore private grants and public federal
government funding options for the purchase of additional mobile dental units to serve special
care populations.
Background 6, 7, 8, 9: Special Care Dentistry Issues
S.L. 2009-100 was a recommendation from the Commission and required the Division of
Public Health, DHHS, to collaborate with the Division of Medical Assistance, the Division of
Aging and Adult Services, the University of North Carolina at Chapel Hill and the East
Carolina University Schools of Dentistry, the North Carolina Dental Society, and current
providers of special care dentistry services, to examine current dental care options for special
care populations. The collaboration of these groups and the report they prepared was
presented to the Commission on March 4, 2010.
The report estimated that NC may be the home of 450,000 individuals requiring special care
North Carolina Study Commission on Aging
Report to the Governor and the 2010 Session of the 2009 General Assembly 31
dentistry services. This number includes individuals with intellectual and/or other
developmental disabilities, those with long term needs due to a Traumatic Brain Injury, and
older adults living with Alzheimer's disease or other types of dementia. However, the report
estimates there are only a small number of dental facilities and practices that employ providers
with the skills and abilities to safely serve dental patients with special health care needs. The
range of service providers includes: State dental clinics serving primarily patients of
psychiatric hospitals, developmental centers, and neuro-medical centers, hospital inpatient
services, two non-profit mobile programs, approximately 150 pediatric dentists that may
accept Medicaid, a limited number of general dentists that treat patients with special needs,
UNC School of Dentistry, and the ECU School of Dentistry which will have a suite dedicated
to patients with special needs in the year 2012. Barriers to care are significant and include
access to care, financial dependency, inadequate care, limited capacity, limited professional
training, limited financial compensation, and no special care dentistry infrastructure to address
concerns.
The presentation to the Commission highlighted a number of the recommendations. On
March 4th, the presenters were asked to prioritize recommendations for the Commission.
These prioritized recommendations are the basis for the special care dentistry
recommendations from the Study Commission on Aging to the 2010 Session of the General
Assembly to enact 2009-SHz-22, 2009-SHz-23, and 2009-SHz-24 .
Recommendation 10: Refining Aging and Long-Term Care Statutes in NC
The Study Commission on Aging recommends the General Assembly update and refine North
Carolina's General Statutes on aging and long-term care.
Background 10: Refining Aging and Long-Term Care Statutes in NC
At the Commission's meeting on April 1, 2010, members received suggestions for
updating and refining language in the North Carolina Statutes that provides a
statement of principles and policy for long-term care and the programs and services
for older adults. The information provided by the Department focused on
amendments to Chapter 143B, Article 3, Part 14A. Policy Act for the Aging, and Part
14B. Long-term Care. The current statutes are provided below.
Part 14A. Policy Act for the Aging.
§ 143B-181.3. Statement of principles.
To utilize effectively the resources of our State, to provide a better quality of life for our senior
citizens, and to assure older adults the right of choosing where and how they want to live, the
following principles are hereby endorsed:
(1) Older people should be able to live as normal a life as possible.
(2) Older adults should have a choice of life styles which will allow them to
remain contributing members of society for as long as possible.
(3) Preventive and primary health care are necessary to keep older adults active
and contributing members of society.
(4) Appropriate training in gerontology and geriatrics should be developed for
individuals serving older adults.
(5) Transportation to meet daily needs and to make accessible a broad range of
services should be provided so that older persons may realize their full
potential.
(6) Services for older adults should be coordinated so that all their needs can be
served efficiently and effectively.
(7) Information on all services for older citizens and advocacy for these services
should be available in each county.
(8) Increased employment opportunities for older adults should be made
available.
North Carolina Study Commission on Aging
Report to the Governor and the 2010 Session of the 2009 General Assembly 32
(9) Options in housing should be made available.
(10) Planning for programs for older citizens should always be done in
consultation with them.
(11) The State should aid older people to help themselves and should encourage
families in caring for their older members.
§ 143B-181.4. Responsibility for policy.
Responsibility for developing policy to carry out the purpose of this Part is vested in the
Secretary of the Department of Health and Human Services as provided in G.S. 143B-181.1 who
may assign responsibility to the Assistant Secretary for Aging. The Assistant Secretary for Aging
shall, at the request of the Secretary, be the bridge between the federal and local level and shall
review policies that affect the well being of older people with the goal of providing a balance in
State programs to meet the social welfare and health needs of the total population. Responsibilities
may include:
(1) Serving as chief advocate for older adults;
(2) Developing the State plan which will aid in the coordination of all programs
for older people;
(3) Providing information and research to identify gaps in existing services;
(4) Promoting the development and expansion of services;
(5) Evaluation of programs;
(6) Bringing together the public and private sectors to provide services for older
people.
Part 14B. Long-Term Care.
§ 143B-181.5. Long-term care policy.
The North Carolina General Assembly finds that the aging of the population and advanced
medical technology have resulted in a growing number of persons who require assistance. The
primary resource for long-term care provision continues to be the family and friends. However,
these traditional caregivers are increasingly employed outside the home. There is growing demand
for improvement and expansion of home and community-based long-term care services to support
and complement the services provided by these informal caregivers.
The North Carolina General Assembly further finds that the public interest would best be
served by a broad array of long-term care services that support persons who need such services in
the home or in the community whenever practicable and that promote individual autonomy, dignity,
and choice.
The North Carolina General Assembly finds that as other long-term care options become more
available, the relative need for institutional care will stabilize or decline relative to the growing
aging population. The General Assembly recognizes, however, that institutional care will continue
to be a critical part of the State's long-term care options and that such services should promote
individual dignity, autonomy, and a home-like environment.
§ 143B-181.6. Purpose and intent.
It is the North Carolina General Assembly's intent in the State's development and
implementation of long-term care policies that:
(1) Long-term care services administered by the Department of Health and
Human Services and other State and local agencies shall include a balanced
array of health, social, and supportive services that promote individual
choice, dignity, and the highest practicable level of independence;
(2) Home and community-based services shall be developed, expanded, or
maintained in order to meet the needs of consumers in the least confusing
manner and based on the desires of the elderly and their families;
(3) All services shall be responsive and appropriate to individual need and shall
be delivered through a seamless system that is flexible and responsive
regardless of funding source;
(4) Services shall be available to all elderly who need them but targeted
primarily to the most frail, needy elderly;
(5) State and local agencies shall maximize the use of limited resources by
establishing a fee system for persons who have the ability to pay;
(6) Institutional care shall be provided in such a manner and in such an
environment as to promote maintenance or enhancement of the quality of life
North Carolina Study Commission on Aging
Report to the Governor and the 2010 Session of the 2009 General Assembly 33
of each resident and timely discharge to a less restrictive care setting when
appropriate; and
(7) State health planning for institutional bed supply shall take into account
increased availability of other home and community-based services options.
The Study Commission on Aging supports efforts to ensure that statutory language supports
service and program delivery goals and efforts through the enactment of 2009-SHz-26.
Recommendation 11: Adult Day Care Participant Protection
The Study Commission on Aging recommends the General Assembly amend North Carolina's
General Statutes to strengthen the authority of the Department of Health and Human Services
to ensure that unfit individuals are prohibited from operating or working in adult day care
programs.
Background 11: Adult Day Care Participant Protection
On April 1, 2010, the Commission received information on the need to strengthen the
Department's authority to safeguard adult day care and adult day health care program
participants.
G.S. 131D-6 provides for the certification of adult day care programs. G.S. 131D-6(b) defines
an adult day care program as the provision of group care and supervision in a place other than
their usual place of abode on a less than 24-hour basis to adults who may be physically or
mentally disabled. On an annual basis, the Department of Health and Human Services is
required to inspect and certify all adult day care programs under the rules adopted by the
Social Services Commission.
G.S. 131D-6(b) requires the Social Services Commission to adopt rules to protect the health,
safety, and welfare of persons in adult day care programs. The rules are required to include
minimum standards relating to management of the programs, staffing requirements, building
requirements, fire safety, sanitation, nutrition, and program activities.
Administrative Rule, 10A NCAC 06R .0305(a)(3), requires a statewide criminal history
records search of all newly-hired employees of adult day programs for the past five years
conducted by an agency approved by the North Carolina Administrative Office of the Courts.
Administrative Rule, 10A NCAC 06R .0508(b)(8)(B) requires an adult day care program to
keep individual personnel records on all staff members including evidence of a state criminal
history check on each employee providing direct care for a minimum of six years.
G.S. 131D-6(c) permits the Secretary to impose a civil penalty not to exceed one hundred
dollars ($100) for each violation on a person, firm, agency, or corporation who willfully
violates any provision of the section or any rule adopted by the Social Services Commission.
The Study Commission on Aging supports thorough background checks and other efforts to
ensure the safety of elderly and disabled residents and recommends the General Assembly
strengthen the statutes accordingly by enacting 2009-SHz-27.
North Carolina Study Commission on Aging
Report to the Governor and the 2010 Session of the 2009 General Assembly
34
APPENDICES
North Carolina Study Commission on Aging
Report to the Governor and the 2010 Session of the 2009 General Assembly 35
APPENDIX A
North Carolina Study Commission on Aging
Report to the Governor and the 2010 Session of the 2009 General Assembly 36
Jamestown
March 24, 2010
Charlotte
April 22, 2010
NC
Study Commission
On Aging
Public Hearing
Spring 2010
North Carolina Study Commission on Aging
Report to the Governor and the 2010 Session of the 2009 General Assembly 37
Background Information
The North Carolina Study Commission on Aging is created to study and evaluate the existing system of
delivery of State services to older adults and to recommend an improved system of delivery to meet the
present and future needs of older adults. This study shall be a continuing one and the evaluation ongoing, as
the population of older citizens grows and as old problems faced by older citizens magnify and are
augmented by new problems. (G.S. 120-180)
The Commission may hold public meetings across the State to solicit public input with respect to the issues
of aging in North Carolina. (G.S. 120-185)
Spring 2010 Public Hearings
Date Location Number of Speakers
March 24, 2010 Jamestown, NC 35
April 22, 2010 Charlotte, NC 25
The issues mentioned with the greatest frequency at both public hearings were:
 Maintain/Increase Home and Community Care Block Grant Funds (21)
 Maintain/Increase Funding for Project C.A.R.E. (21)
 Increase Funds/Support for Adult Day Care (11)
North Carolina Study Commission on Aging
Report to the Governor and the 2010 Session of the 2009 General Assembly 38
Frequency of Issues Expressed by Speakers
JAMESTOWN CHARLOTTE TOTAL
ISSUES FREQUENCY FREQUENCY FREQUENCY
Maintain /Increase HCCBG Funding 15 6 21
Maintain/Increase Funding for Project C.A.R.E. 12 9 21
Maintain/Increase Funding and Support for Adult Day Care 8 3 11
Support Funding for Medicaid Personal Care Services (PCS) 4 4 8
Maintain/Increase Funding for New & Existing Special Care Dental Programs 4 2 6
Maintain/Increase Senior Center Funds 3 2 5
Support for Senior Games 1 4 5
Support for Long-Term Care Partnership Program 2 2 4
Increase Homestead Exemption/ Property Tax Relief for Seniors 2 1 3
Support Funding for Medicaid Community Alternatives Programs (CAP-DA) 0 3 3
Support Increasing Medicaid Personal Needs Allowance 1 2 3
Provide Appropriate Housing for Mentally Ill, No Mixing of Elderly and Mentally Ill 1 1 2
Support for Home and Hospice Care 0 2 2
Drug Testing for Employees in Adult Care Homes 1 1 2
Increase Transportation Funding for Seniors 0 1 1
Address Issues Related to Mentally Ill in Adult Care Homes/ Mixing Populations 1 0 1
Additional Protection for the Elderly: Consumer Protection, Lifeline for Seniors 1 0 1
APPENDIX B
North Carolina Study Commission on Aging
Report to the Governor and the 2010 Session of the 2009 General Assembly
40
GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2009
U D
BILL DRAFT 2009-SHz-20 [v.2] (04/01)
(THIS IS A DRAFT AND IS NOT READY FOR INTRODUCTION)
4/26/2010 3:55:56 PM
Short Title: Consumer Guidelines for Hearing Aid Purchases. (Public)
Sponsors: .
Referred to:
A 1 BILL TO BE ENTITLED
2 AN ACT TO REQUIRE THE HEARING AID DEALERS AND FITTERS BOARD
3 TO COORDINATE A TASK FORCE THAT WILL DEVELOP GUIDELINES
4 FOR CONSUMERS TO USE WHEN PURCHASING A HEARING AID, AS
5 RECOMMENDED BY THE NORTH CAROLINA STUDY COMMISSION ON
6 AGING.
7 The General Assembly of North Carolina enacts:
8 SECTION 1.(a) The Hearing Aid Dealers and Fitters Board shall coordinate
9 a task force which shall develop recommended guidelines for consumers seeking
10 information and assistance in the treatment of hearing loss and the purchase of a hearing
11 aid. The task force shall include representatives of the Hearing Aid Dealers and Fitters
12 Board; the Division of Services for the Deaf and Hard of Hearing, Department of Health
13 and Human Services; the Consumer Protection Division, Office of the Attorney
14 General; and may include other interested stakeholders.
15 SECTION 1.(b) The Hearing Aid Dealers and Fitters Board shall report the
16 findings and recommendations of the task force, along with recommendations on
17 methods to disseminate hearing aid purchasing guidelines, to the North Carolina Study
18 Commission on Aging on or before October 15, 2010.
19 SECTION 2. This act is effective when it becomes law.
North Carolina Study Commission on Aging
Report to the Governor and the 2010 Session of the 2009 General Assembly
41
GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2009
U D
BILL DRAFT 2009-SHz-21 [v.2] (04/01)
(THIS IS A DRAFT AND IS NOT READY FOR INTRODUCTION)
4/29/2010 2:41:43 PM
Short Title: Nurse Aide Training Review. (Public)
Sponsors: .
Referred to:
A 1 BILL TO BE ENTITLED
2 AN ACT TO DIRECT THE DIVISION OF HEALTH SERVICE REGULATION,
3 DEPARTMENT OF HEALTH AND HUMAN SERVICES, TO COORDINATE A
4 REVIEW OF THE EDUCATION AND TRAINING REQUIREMENTS FOR
5 NURSE AIDES, AS RECOMMENDED BY THE NORTH CAROLINA STUDY
6 COMMISSION ON AGING.
7 The General Assembly of North Carolina enacts:
8 SECTION 1.(a).The Division of Health Service Regulation, Department of
9 Health and Human Services, shall coordinate a review of the education and training
10 requirements for nurse aides. In conducting the review, the Division shall include an
11 equal number of representatives from the Division of Health Service Regulation;
12 Division of Aging and Adult Services; the North Carolina Board of Nursing; the Direct
13 Care Workers Association of North Carolina; the North Carolina Health Care Facilities
14 Association; the North Carolina Hospital Association; the Association for Home and
15 Hospice Care of North Carolina; and individuals representing residents in long-term
16 care. The review shall include an evaluation of the current education and training
17 requirements for nurse aides.
18 SECTION 1.(b). The Division of Health Service Regulation shall
19 report findings and recommendations on the appropriate levels of education and training
20 for nurse aides to the North Carolina Study Commission on Aging on or before
21 November 1, 2010.
22 SECTION 2. This act is effective when it becomes law.
North Carolina Study Commission on Aging
Report to the Governor and the 2010 Session of the 2009 General Assembly
42
GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2009
U D
BILL DRAFT 2009-SHz-25 [v.7] (04/01)
(THIS IS A DRAFT AND IS NOT READY FOR INTRODUCTION)
4/29/2010 4:52:59 PM
Short Title: Implement LTC Partnership Program. (Public)
Sponsors: .
Referred to:
A 1 BILL TO BE ENTITLED
2 AN ACT TO IMPLEMENT THE LONG-TERM CARE PARTNERSHIP PROGRAM,
3 TO ENSURE THAT NORTH CAROLINA'S LONG-TERM CARE INSURANCE
4 LAWS COMPORT WITH THE LONG-TERM CARE PARTNERSHIP
5 PROVISIONS IN THE FEDERAL DEFICIT REDUCTION ACT OF 2005, AND
6 TO AUTHORIZE THE SHARING OF CONFIDENTIAL INFORMATION
7 BETWEEN THE NORTH CAROLINA DEPARTMENT OF INSURANCE,
8 ENTITIES THAT CONTRACT WITH THE FEDERAL GOVERNMENT, AND
9 OTHER GOVERNMENTAL AGENCIES, AS RECOMMENDED BY THE
10 NORTH CAROLINA STUDY COMMISSION ON AGING.
11 The General Assembly of North Carolina enacts:
12 SECTION 1. Part 6, Article 2 of Chapter 108A of the General Statutes is
13 amended by adding a new section to read:
14 "§ 108A-70.4. Long-Term Care Partnership Program.
15 (a) As used in this section, the terms:
16 (1) "Asset" means resources and income.
17 (2) "Department" means the Department of Health and Human Services,
18 Division of Medical Assistance.
19 (3) "Estate recovery" means the placing of a statutory claim pursuant to
20 108A-70.5 on the estate of the deceased Medicaid recipient.
21 (4) "Long-term care partnership policy" means a long-term care insurance
22 policy approved by the North Carolina Department of Insurance as
23 meeting all of the regulations and requirements of the model Act
24 promulgated by the National Association of Insurance Commissioners.
25 (5) "Medicaid" means the federal medical assistance program established
26 under Title XIX of the Social Security Act.
North Carolina Study Commission on Aging
Report to the Governor and the 2010 Session of the 2009 General Assembly
43
(6) "Resource" means cash or its 1 equivalent and or real or personal
2 property that is available to the applicant or recipient.
3 (7) "Resource disregard" means the amount of resources owned by the
4 long-term care Medicaid applicant that is equal to the amount of
5 benefits paid by a long-term care partnership policy for the applicant
6 which will not be counted when determining long-term care Medicaid
7 eligibility.
8 (8) "Resource protection" means an amount equal to the resource
9 disregard given to the recipient at long-term care Medicaid eligibility
10 that will be deducted from the total estate value at estate recovery.
11 (b) Since the Deficit Reduction Act of 2005 repealed the restrictions to resource
12 protection contained in the Omnibus Budget Reconciliation Act of 1993, P.L. 103-66,
13 107 Stat.312, there is established the North Carolina Long-Term Care Partnership
14 Program to be administered by the Department with assistance from the North Carolina
15 Department of Insurance. The North Carolina Long-Term Care Partnership Program
16 shall:
17 (1) Provide a mechanism for individuals to qualify for coverage of the cost
18 of their long-term care needs under Medicaid without first being
19 required to substantially exhaust their resources.
20 (2) Provide counseling services to individuals planning for their long-term
21 care needs.
22 (3) Alleviate the financial burden on the State's medical assistance
23 program by encouraging the pursuit of private insurance.
24 (c) In the case of an individual who has received benefits under a long-term care
25 partnership policy, an equal amount of resources shall not be considered by the
26 Department during the determination of the following:
27 (1) Eligibility for long-term care Medicaid.
28 (2) Any subsequent recovery by the State from a deceased recipient's
29 estate for payment of Medicaid paid services.
30 (d) The Department shall promulgate necessary rules and amendments to the
31 State Plan to allow for resource disregard at long-term care Medicaid eligibility
32 determination and resource protection at estate recovery. To provide resource disregards
33 for purchases of a long-term care partnership policy, the Department shall count
34 insurance benefits paid under the policy prior to the date of the first application for
35 long-term care Medicaid made after the implementation of the program toward resource
36 disregard and resource protection to the extent the payments are for covered services
37 under the long-term care partnership policy.
38 (e) After January 1, 2011, or 60 days after approval of the Medicaid State Plan
39 amendment, whichever is later, a qualified long-term care partnership policy shall
40 contain a disclosure detailing in plain language the current law pertaining to resource
41 disregard and resource protection. A duplicate disclosure shall be given to the insured
42 individual with the delivery of the policy document.
43 (f) The Department shall enter into a reciprocal agreement with other states that
44 enter into a national reciprocity agreement to extend the resource disregard and resource
North Carolina Study Commission on Aging
Report to the Governor and the 2010 Session of the 2009 General Assembly
44
protection to residents of the State who purchased, 1 or purchased and used, a qualified
2 long-term care policy in another state.
3 (g) The Department and the Department of Insurance are authorized to adopt
4 rules to implement the provisions of this program for its administration.
5 (h) In the case of an individual that has received benefits under a long-term care
6 partnership policy, the provisions of G.S. 108A-70.5 remain in effect for purposes of
7 estate recovery, with the exception of the definition of "estate" under
8 G.S. 108A-70.5(b)(2). In accordance with Title XIX of the Social Security Act, 42
9 U.S.C. § 1396p(b)(4)(B), the definition of "estate" for an individual who has received
10 benefits under a long-term care partnership policy includes any other real or personal
11 property and other assets in which the individual had any legal title or interest at the
12 time of death (to the extent of such interest), including such assets conveyed to a
13 survivor, heir, or assign of the deceased individual through joint tenancy, tenancy in
14 common, survivorship, life estate, living trust, or other arrangement."
15 SECTION 2. G.S. 108A-70.5 reads as rewritten:
16 "§ 108A-70.5. Medicaid Estate Recovery Plan.
17 (a) There is established in the Department of Health and Human Services, the
18 Medicaid Estate Recovery Plan, as required by the Omnibus Budget Reconciliation Act
19 of 1993, to recover from the estates of recipients of medical assistance an equitable
20 amount of the State and federal shares of the cost paid for the recipient. The Department
21 shall administer the program in accordance with applicable federal law and regulations,
22 including those under Title XIX of the Social Security Act, 42 U.S.C. § 1396(p).
23 (b) As used in this section:
24 (1) "Medical assistance" means medical care services paid for by the
25 North Carolina Medicaid Program on behalf of the recipient:
26 a. If the recipient of any age is receiving medical care services as
27 an inpatient in a nursing facility, intermediate care facility for
28 the mentally retarded, or other medical institution, and cannot
29 reasonably be expected to be discharged to return home; or
30 b. If the recipient is 55 years of age or older and is receiving one
31 or more of the following medical care services:
32 1. Nursing facility services.
33 2. Home and community-based services.
34 3. Hospital care.
35 3a. Prescription drugs.
36 4. Personal care services.
37 5 through 9. Repealed by Session Laws 2007-442, s. 1,
38 effective August 23, 2007.
39 (2) "Estate" means all the real and personal property considered assets of
40 the estate available for the discharge of debt pursuant to
41 G.S. 28A-15-1. For individuals who have received long-term care
42 benefits as described in G.S. 108A-70.4, "estate" also includes any
43 other real and personal property and other assets in which the
44 individual had any legal title or interest at the time of death (to the
North Carolina Study Commission on Aging
Report to the Governor and the 2010 Session of the 2009 General Assembly
45
extent of such interest), including 1 such assets conveyed to a survivor,
2 heir, or assign of the deceased individual through joint tenancy,
3 tenancy in common, survivorship, life estate, living trust, or other
4 arrangement.
5 (3) Repealed by Session Laws 2007-442, s. 1, effective August 23, 2007.
6 (c) The amount the Department recovers from the estate of any recipient shall not
7 exceed the amount of medical assistance made on behalf of the recipient and shall be
8 recoverable only for medical care services prescribed in subsection (b) of this section.
9 The Department is a fifth-class creditor, as prescribed in G.S. 28A-19-6, for purposes of
10 determining the order of claims against an estate; provided, however, that judgments in
11 favor of other fifth-class creditors docketed and in force before the Department seeks
12 recovery for medical assistance shall be paid prior to recovery by the Department.
13 (d) The Department of Health and Human Services shall adopt rules pursuant to
14 Chapter 150B of the General Statutes to implement the Plan, including rules to waive
15 whole or partial recovery when this recovery would be inequitable because it would
16 work an undue hardship or because it would not be administratively cost-effective and
17 rules to ensure that all recipients are notified that their estates are subject to recovery at
18 the time they become eligible to receive medical assistance.
19 (e) Repealed by Session Laws 2007-442, s. 1, effective August 23, 2007."
20 SECTION 3. Article 55 of Chapter 58 of the General Statutes is amended
21 by designating G. S. 58-55-1 through G.S. 58-55-50 as "Part 1. General Provisions."
22 SECTION 4. Article 55 of Chapter 58 of the General Statutes is amended
23 by adding a new Part to read:
24 "Part 2. Long-Term Care Partnership.
25 "§ 58-55-55 Long-Term Care Partnership.
26 (a) A long-term care partnership policy is a long-term care insurance policy
27 including a certificate issued under a group insurance contract.
28 (b) A long-term care partnership policy must satisfy all of the following
29 requirements:
30 (1) The policy must be a qualified long-term care insurance contract, as
31 defined in section 7702B of the Internal Revenue Code of 1986 (26
32 U.S.C. 7702B(b)) and must provide insurance benefits on a
33 reimbursement, case benefit basis, indemnity insurance basis or on a
34 per diem or other periodic basis.
35 (2) The effective date of the coverage is on or after January 1, 2011, or 60
36 days after approval of the Medicaid State Plan amendment, whichever
37 is later.
38 (3) The policy covers an insured who was a resident of North Carolina or
39 another state that has entered into a reciprocal agreement with North
40 Carolina when coverage first became effective under the policy. If the
41 policy is later exchanged for a different long-term care policy, the
42 individual was a resident of North Carolina or another state that has
43 entered into a reciprocal agreement with North Carolina when
44 coverage under the earliest policy became effective.
North Carolina Study Commission on Aging
Report to the Governor and the 2010 Session of the 2009 General Assembly
46
(4) The policy meets the federal 1 consumer protection requirements of
2 section 1917(b)(5)(A) of the Social Security Act (42 U.S.C.
3 1396p(b)(5)(A). In addition, the policy must:
4 (a) Provide the insurer will issue a 90 day notice prior to
5 exhaustion of a long-term care partnership policy. The notice
6 shall instruct the insured to go to his local department of social
7 services to apply for Medicaid.
8 (b) The policy must designate a third party who shall receive
9 premium due notices in addition to the insured, including the
10 notice required in G.S. 58-55-55(4)(a) to prevent loss of
11 benefits due to non-payment.
12 (5) The policy is issued with and retains inflation coverage which meets
13 the following inflation coverage limitations:
14 (a) Policies or certificates issued to an individual who is under 61
15 years old must provide compound annual inflation protection.
16 (b) Policies or certificates issued to an individual who is 61 to 76
17 years old must provide some level of inflation protection. This
18 may include simple interest or compound inflation protection.
19 (c) For purchasers 76 years old or older, inflation protection may
20 be offered but in not required.
21 (6) The policy states that it is intended to be a qualified long-term care
22 insurance policy as defined in section 7702B(b) of the Internal
23 Revenue Code of 1986.
24 (7) The policy is issued in North Carolina or issued for delivery in North
25 Carolina and shall include a "Partnership Status Disclosure Notice".
26 The notice shall state the following in at least 12-point font:
27 "At the time of issuance, this long-term care insurance policy qualifies
28 as a North Carolina Long-Term Care Partnership Program policy.
29 For Medicaid applicants applying for help with the cost of long-term
30 care, this means that an amount of your resources equal to the dollar
31 amount of long-term care insurance benefits paid to you or on your
32 behalf under this policy may be disregarded for purposes of
33 determining your eligibility for long-term care Medicaid. The amount
34 that will be disregarded at eligibility will be equal to the amount of the
35 long-term care partnership benefits paid out prior to the time you
36 apply for long-term care Medicaid. As a result, you may qualify for
37 coverage of the cost of your long-term care needs under Medicaid
38 without first being required to substantially exhaust you personal
39 resources. If you are already a recipient of long-term care Medicaid,
40 this policy will not allow a resource disregard or estate recovery
41 resource protection.
42
43 Please note that this policy may lose long-term care partnership
44 program status if you move to a different state that does not recognize
North Carolina Study Commission on Aging
Report to the Governor and the 2010 Session of the 2009 General Assembly
47
North Carolina's Long Term 1 Care Partnership Program or you modify
2 this policy after issuance. This policy may also lose long-term care
3 partnership program status due to changes in federal or state laws.
4
5 If you have questions regarding long-term care insurance and the
6 North Carolina Long-Term Care Partnership Program, you may
7 contact the Seniors' Health Insurance Information Program of the
8 Department of Insurance at 1-800-443-9354.
9
10 In the case of a group insurance contract, such Notice shall be
11 provided to the insured upon the issuance of the certificate. The
12 Insurer shall include in that notice that the amount of the insured
13 resources that will be disregarded at eligibility will be equal to the
14 amount of long-term care partnership policy benefits paid prior to the
15 time the insured applied for long-term care Medicaid. The Insurer shall
16 also include in the notice a warning to the insured that the policy may
17 lose long-term care partnership program status if the insured moves to
18 another state that does not recognize North Carolina's Long-Term Care
19 Partnership Program, or if the policy is modified after issuance."
20 "§ 58-55-56. Compliance with Federal Regulation.
21 (a) The Commissioner may adopt rules to conform long-term care policies and
22 certificates to the requirements of federal law and regulations, including any changes
23 required by Congress or the U.S. Department of Health and Human Services, or any
24 successor agencies.
25 (b) The tax-qualified long-term care provisions required of the Health Insurance
26 Portability and Accountability Act of 1996, including subsequent amendments and
27 editions, are hereby incorporated into Article 55 of Chapter 58.
28 (c) The long-term care partnership provisions required of the Deficit Reduction
29 Act of 2005, including subsequent amendments and editions, are hereby incorporated
30 into Article 55 of Chapter 58.
31 "§ 58-55-57. Disclosure Notices.
32 (a) Prior to an insured making a change to the policy that will result in the loss of
33 long-term care partnership status, the insurer shall provide to the policyholder a written
34 explanation of how such action impacts the insured and shall obtain the insured's
35 signature indicating consent to the change.
36 (b) If a long-term care partnership plan subsequently loses long-term care
37 partnership status, the insurer shall explain in writing to the policyholders the reason for
38 the loss of status.
39 (c) The disclosures required in this section shall be provided to any insured who
40 exchanges a policy for a long-term care partnership policy.
41 "§ G.S. 58-55-58. Exchange of Long-Term Care Policies for Long-Term Care
42 Partnership Policies.
43 A long-term care insurance policy that does not qualify as a long-term care partnership
44 policy and that was issued prior to January 1, 2011, or 60 days following approval of the
North Carolina Study Commission on Aging
Report to the Governor and the 2010 Session of the 2009 General Assembly
48
Medicaid State Plan amendment, whichever is later, shall be 1 eligible for long-term care
2 partnership status if those policies meet the federal requirements of a long-term care
3 partnership policy. If an exchange occurs, the insurer shall notify the insured in writing
4 that the new long-term care partnership policy may be subject to underwriting criteria
5 and premium adjustment. The effective date of the long-term care partnership policy
6 shall be the date the policy was exchanged."
7 SECTION 5. Article 55 of Chapter 58 of the General Statutes is amended by
8 adding a new section to read:
9 "§ 58-55-36. Information sharing.
10 (a) In order to assist in the performance of the Commissioner's duties under the
11 long-term care partnership program specified in the federal Deficit Reduction Act of
12 2005, the Commissioner may:
13 (1) Share information, including identifying information, related to the
14 long-term care partnership program with other state and federal
15 agencies, the National Association of Insurance Commissioners, and
16 any entity contracting with the federal government under the Program,
17 provided that the recipient agrees to maintain the confidentiality and
18 privileged status of the information.
19 (2) Receive information, including identifying information, related to the
20 long-term care partnership program from other state and federal
21 agencies, the National Association of Insurance Commissioners, and
22 any entity contracting with the federal government under the Program,
23 and shall maintain as confidential or privileged any identifying
24 information received with notice or the understanding that it is
25 confidential or privileged under the laws of the jurisdiction that is the
26 source of the document, material, or information.
27 (3) Enter into agreements governing sharing and use of information
28 consistent with this section.
29 (b) No waiver of an existing privilege or claim of confidentiality in the
30 identifying information shall occur as a result of disclosure to the Commissioner under
31 this section or as a result of sharing as authorized in subsection (a) of this section.
32 (c) A privilege established under the law of any state or jurisdiction that is
33 substantially similar to the privilege established under this section shall be available and
34 enforced in any proceeding in, and in any court of, this State.
35 (d) As used in this section, "identifying information" has the same meaning as in
36 G.S. 14-113.20(b)."
37 SECTION 6. The Department of Health and Human Services and the
38 Department of Iinsurance may adopt rules to implement the Long-Term Care
39 Partnership Program in North Carolina.
40 SECTION 7. The Department of Health and Human Services shall pursue
41 a Medicaid State Plan amendment to allow the Long-Term Care Partnership Program to
42 operate in North Carolina.
North Carolina Study Commission on Aging
Report to the Governor and the 2010 Session of the 2009 General Assembly
49
SECTION 8. Sections 7 and 8 of this act are 1 effective when they become
2 law, the remainder of the act becomes effective January 1, 2011, or 60 days after
3 approval of the Medicaid State Plan amendment, whichever is later.
North Carolina Study Commission on Aging
Report to the Governor and the 2010 Session of the 2009 General Assembly
50
GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2009
U D
BILL DRAFT 2009-SHz-22 [v.1] (04/01)
(THIS IS A DRAFT AND IS NOT READY FOR INTRODUCTION)
4/14/2010 1:22:29 PM
Short Title: Comsn. on Children with Special Needs-Dentist. (Public)
Sponsors: .
Referred to:
A 1 BILL TO BE ENTITLED
2 AN ACT TO ADD A LICENSED DENTIST TO THE COMMISSION ON
3 CHILDREN WITH SPECIAL HEALTH CARE NEEDS, AS RECOMMENDED
4 BY THE NORTH CAROLINA STUDY COMMISSION ON AGING.
5 The General Assembly of North Carolina enacts:
6 SECTION 1. G.S. 143-682 reads as rewritten:
7 "§ 143-682. Commission established.
8 (a) There is established the Commission on Children With Special Health Care
9 Needs. The Department of Health and Human Services shall provide staff services and
10 space for Commission meetings. The purpose of the Commission is to monitor and
11 evaluate the availability and provision of health services to special needs children in this
12 State, and to monitor and evaluate services provided to special needs children under the
13 Health Insurance Program for Children established under Part 8 of Article 2 of Chapter
14 108A of the General Statutes.
15 (b) The Commission shall consist of eight nine members appointed by the
16 Governor, as follows:
17