Disability Rights North Carolina’s Comments on the Technical Assistance Collaborative and Human Services Research Institute’s “An Assessment of the North Carolina Department of Health and Human Services’ System of Supports for Individuals with Disabilities


DRNC would like to acknowledge and express gratitude for all the time and care stakeholders have dedicated to providing input for “An Assessment of the North Carolina Department of Health and Human Services’ System of Supports for Individuals with Disabilities” (“Assessment”).

Through these comments, we are urging the state to move beyond planning processes to take vigorous action to move its long-term care systems’ over-reliance on institutions, and invest in community-based, integrated services and supports. DRNC is deeply troubled by the extent to which the information in this report was available to all of us long before now, and that this information has yet to be acted upon. We have known for many years that the state over-invests in segregated systems and under-invests in community-based and evidence-based models. There are actions that could have been taken to address this imbalance during the time we awaited this latest report, yet those actions were not taken.

A clear, definitive, public commitment to building an adequate community service system must be made now, as it is a prerequisite for ending the over-use of institutional settings. Racial inequities and other disparities noted in the Assessment, magnified by the dangers of mass institutionalization exposed by the pandemic, add to the urgent need for action. The lives of people with disabilities hang in the balance, and time is up.


1. Olmstead is a State obligation and implementing an effective plan will require commitment, engagement, and investment at the State level.

DHHS has a central role to play in ensuring that people with disabilities can live, work, and play in integrated settings. However, Olmstead obligations apply across state government, including criminal justice, guardianship, housing, and myriad other contexts. An effective Olmstead Plan must be a plan for the State as a whole, and not just one department.

The Assessment, by its own title and terms, was limited to DHHS. We are concerned that basing an Olmstead Plan only on the Assessment, with its limited purview, will render the Plan ineffective. Fulfilling the State’s obligation requires engagement and commitment across branches and agencies. Priorities must be aligned and there must be unambiguous commitment to integration. This is not currently the case. By way of example, the Assessment notes the State’s overinvestment in State-operated institutions, and the importance of repurposing funds from institutional to community settings. At the very same time, the Governor has proposed to spend $20 million of the State’s American Rescue Plan Budget on “repairs and renovations at DHHS hospitals and treatment centers around the state.” As astounding as this contradiction is on its own, it is particularly troubling in the context of federal dollars aimed at COVID-19 relief being invested in bolstering congregate settings.

The accompanying spreadsheet summarizes certain similarities between documents produced in the last 10 years regarding North Carolina’s failure to comply with Olmstead v. LC. The purpose of compiling the attached document is to create a visual representation of the well-established conclusions reached repeatedly over the last 10 years. These conclusions include, of course, that the State must invest more in community-based services and reduce reliance on institutional settings. However, the most important conclusion of these documents is that change requires leadership to commit and act.

2. There are actions that did not need to wait, that can be taken now, and that should not wait until a plan is released in January 2022.

DRNC wrote to the Secretary on November 21, 2019 regarding the issuance of an RFP that led to the Assessment. (A copy of that letter is attached.) We noted, as to each deliverable in the RFP, where the requested information could be found in DHHS’s own publications and records. Most of these references were to the 2018 Strategic Plan for Improvement of Behavioral Health Services, produced by DHHS just one year before. Our concern was that change would be delayed while a well-studied issue was studied again. That has happened, as it has many times in the past.

DRNC has previously asked the State to take many of the steps identified by TAC/HSRI, as have other stakeholders. These include: enforcing LME/MCO contracts with regard to Olmstead obligations, provider networks, and the use of facilities; addressing pay deficiencies that drive the workforce shortage, including the disparity in pay between community-based and facility-based workforces; and of course addressing waiting lists for services.

We agree with OPSA Co-Chair Betsy MacMichael’s comments at the May 12, 2021 OPSA meeting that, regardless of past failures to act, stakeholders and State staff should now be looking and working toward change. As stakeholders continue to invest their time and energy into this work, they have a right to expect a demonstration that this time is different. To that end, and in summary of the above, DRNC asks:

  1. that the Secretary and the Governor issue definitive public statements of commitment to the adoption and implementation of an effective Olmstead Plan across State government; and
  2. that DHHS identify improvements that can be made concurrently with overall planning and publicly commit to take action on those improvements immediately.

Letter to Secretary Cohen

November 21, 2019

View Letter

Common Features of 10 Years of Olmstead Analysis (see note)

2011 HSRI Report

2011 DOJ Findings

2017 Samantha R Litigation

2018 Strategic Plan

2021 TAC/HSRI Report

Compiled state and national data pp. 2-3 NA NA pp. 4, 20, 65-87 pp. 19-22,
Conducted stakeholder interviews and surveys p. 3 p. 3 NA p. 7 pp. 16-18
Report labeled a “first step” toward improvements p. 1 NA NA p. 3 p. 6
Described instutional settings pp. 31-33 p. 2 (ACHs) Complaint pp. 6-11 pp. 14-18, 55-60 pp. 55-67
Reported data on unmet need for HCBS pp. 23-24 p. 5 NA pp. 10-14, 20-23, 6776 pp. 68-81
Reported length of waiver waitlist p. 19 (8,191) NA Complaint p. 17
p. 13 (11,308)
pp. 9, 97-98 (14,400)
Concluded that more HCBS are needed pp. 40-45, 61-62 pp. 2, 5, 11 Complaint pp. 15-17 pp. 5, 22, 26, 88-90 pp. 9-10, 68-81
Concluded there are workforce shortages pp. 51-52 NA Complaint p. 16 pp. 31, 34-35 pp. 91-92, 124
Concluded that NC must train/pay DSPs better pp. 51-52 NA NA pp. 34-35, 38 pp. 91-92, 124
Concluded lack of HCBS creates risk of institutionalization pp. 25, 61 p. 6 Complaint pp. 15-
pp, 22, 87 pp. 109-113
Concluded there is overreliance on institutions pp. 25, 31, 42-45, 61 pp. 2, 5-6 Court Order, 2/4/20 pp. 5, 20, 22, 87 pp. 53-54, 116
Articulated NC’s institutional bias in violation of
pp. 25, 61-62 pp. 2-3, 5-6 Court Order, 2/4/20 pp. 5, 22, 87 pp. 53-54
Cited to earlier reports of institutional bias pp. 13, 28, 29, 32, 37 p. 9 Complaint p. 24 NA pp. 18, 177
Concluded that change requires leadership to commit and act pp. 59-60 p. 4 NA pp. 4, 18, 20 pp. 12-13


The documents referenced are not the only ones that could have been included, and there are other commonalities not summarized here.
The documents covered are:
A Strategic Analysis for Change , Human Services Research
Institute, August
Findings Letter , U.S.
Department of
Justice, July 30,
Samantha R. v. DHHS litigation documents , 20172020 Strategic Plan for
Improvement of
Behavioral Health
Services , NC DHHS,
January 31, 2018
An Assessment of the
NCDHHS’ System of Services and Supports for Individuals with
Disabilities, TAC/HSRI
April 30, 2021