North Carolina Olmstead Plan

Providing a foundation for North Carolina's Olmstead Plan

In 2020, HSRI assisted its longtime partner the Technical Assistance Collaborative with a project with the North Carolina Department of Health and Human Services. TAC and HSRI assessed the state’s system of services and supports for people disabilities and made recommendations for the state’s plan to provide care in the most integrated settings as required under the Supreme Court’s landmark Olmstead decision.


The findings provide a foundation for the development of North Carlina’s Olmstead Plan to ensure people with disabilities are served in the least restrictive, most integrated settings appropriate to their needs. The findings also inform technical assistance for implementation and performance measurement. 

  • Data Collection and Analysis
  • Systems Change

Analyzing data from agencies serving people with disabilities

This comprehensive analysis included five target populations: Medicaid-eligible and non-insured individuals of all ages who have intellectual or developmental disabilities (IDD), mental health and/or substance use disorders, Traumatic Brain Injury (TBI), or physical disabilities.

For these target groups, HSRI obtained and analyzed data from the following sources:

  • Claim/encounter data for Medicaid-funded services and supports
  • Claim/encounter data for services and supports funded by NC DHHS
  • Data from the state’s Division of State-Operated Healthcare Facilities (DSOHF)

Synthesizing findings with other secondary data

In addition to analysis of claims data, we identified and synthesized state-level data from publicly available data systems and reports to drive recommendations, including SAMHSA Uniform Reporting System (URS), National Core Indicators, the Residential Information Systems Project (RISP), the NC Division of Vocational Rehabilitation Services, and many others.

The Results

North Carolina spends a disproportionate amount of its resources on institutional and congregate care settings. It spends more to serve individuals in congregate care settings than it spends on community-integrated service options.

Local Management Entities/Managed Care Organizations (LME/MCOs) are responsible for statewide management and oversight of the public system of mental health, developmental disabilities, and substance use disorder services at the community level. We found variation in service penetration across the LME/MCOs that do not appear to impact the use of state psychiatric beds.

There are disparities in service penetration, with African-Americans disproportionately represented in state psychiatric hospitals and crisis services.

The findings from our data analysis, in combination with qualitative data collected through key informant interviews and stakeholder listening sessions, led to the development of detailed recommendations for North Carolina to reduce its reliance on institutional care for people with disabilities.

The Report

An Assessment of the North Carolina Department of Health and Human Services’ System of Services and Supports for Individuals with Disabilities


North Carolina Department of Health and Human Services

Project Partner(s):

Technical Assistance Collaborative

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