Care Extender Policy Paper

In April of 2022, The North Carolina Department of Health and Human Services (DHHS) published a new waiver service definition: Care Extenders. This new service definition includes the incorporation of people with lived experience and their family members into a paid service and presents a unique opportunity to advance Family Navigation and Peer Support Services for people with I/DD in North Carolina.

While the proposed Care Extender service definition creates a pivotal opportunity to advance paid, professional family navigation and peer support in the I/DD service system, it has come at a challenging time. The I/DD, Behavioral Health, and Medicaid service delivery systems are undergoing a seismic shift as they transition from the current LME-MCO and fee-for-service physical health model to the NC Medicaid Managed Care Behavioral Health and Intellectual/ Developmental Disabilities Tailored Plan on April 1, 2023.

The North Carolina Council on Developmental Disabilities (NCCDD) funded Community Bridges to develop a Care Extender Policy Paper that summarizes the perspectives of families, individuals with I/DD, LME MCOs, DD Providers, policymakers, and healthcare providers AND identifies strategic recommendations to address potential challenges that could impact success.

This report includes:

  • Strategic recommendations for short-term, midterm, and long-term implementation and growth of family navigation and peer support in the proposed Care Extender definition, focusing on scalability and sustainability.
  • Identification of policies that support and limit family navigation and peer support in the Care Extender definition.
  • Identification of changes in practices that promote statewide adoption of family and peers as care extenders.
  • Scenarios that illustrate the role that family navigation and peer support can have in achieving valued outcomes and how they align with value-based care and reimbursement.