Wilmington NC Counseling Blog

I Am Pissed About North Carolina Intensive In-Home!

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I am officially pissed!

I read yesterday that effective October 1st, 2014, the service definition for intensive in-home has been changed so that IIH teams can now carry a caseload of 12 families, up from 8 families!!

This is a 50% increase in workload for what raise?

0% raise!

If you want to see the actual letter take a look at this link: Letter from North Carolina Department of Health and Human Services.

If you don’t want to read the letter, the important information is below.

The Letter With Important Words Bolded

Here is the important section:

The Department of Health and Human Services, Division of Medical Assistance hereby provides notice
of its intent to amend the Medicaid State Plan pages Attachment 4.19-B, Section 13, Page 7 and
Attachment 4.19-B, Supplement 6, Page 7. Effective October 1, 2014, the team-to-family ratio in the
Intensive In-Home (IIH) service definition is revised from 1:8 to 1:12. Effective January 1, 2015, the
reimbursement rate for IIH is reduced by 1%. This change in methodology is required by Sections 12H.4
and 12H.14A of Session Law 2014 – 100.

Calling Out NC-NASW

I am calling out the North Carolina National Association of Social Workers. Hello?  Hello?  WHERE ARE YOU??

In North Carolina social workers cannot unionize, but we can turn to our professional organization, NASW-NC.

Readers please do me a favor and take a look at the NC-NASW advocacy webpage and search for any comment or statement on a 50% workload increase on NC IIH social workers:


Do you see a statement about this 50% workload increase on the backs of North Carolina social workers? If you do see a statement please send it to me so I won’t feel left out in the cold by my professional organization.

Please also look at the NC social work news:


See anything there? I don’t.

Of what use is a professional organization if it does not support, advocate, and lobby for its members?

Calling Out Agencies

There are some fantastic agencies out there. I know many that are exceptionally managed with exceptional supervisors who have made their way through the ranks of social work or related fields.

I am calling out these administrators to recognize that they are a part of the mental health field and their allegiance should be with front line workers and not the business managers of their agencies.

That is a hard thing to say.

So, let me say it again: Administrators should recognize that they are a part of the mental health field and their allegiance should be with front line workers and not the business managers of their agencies.

What does this mean?

It means that even though agencies can now legally work their front line workers 50% harder for NO salary increase, and can POCKET the money in profit because their salary expenses are not going up, that it is morally the wrong thing to do.

It is simply wrong to continue to push intensive in-home workers, many of whom are LCSWAs, who are already doing the best job they can being new to the field, driving all over various counties for horrible milage reimbursement rates, being on-call and dealing with crisis situations in their off hours and doing these things because extended service jobs are the only jobs available to them.

LCSWA’s cannot be reimbursed in outpatient care so they are forced into extended services to get licensed. They do the jobs that fully licensed practitioners won’t do because most fully licensed workers won’t put up with the hours and intensity of intensive in-home work.

This is essentially hazing of new social workers and is fodder for another post.

Mental Health Workers Deserve Better

Mental health workers are fantastic people who have devoted their lives to helping others. We care, we work hard, we matter, and when decisions are made like the one made this past week making it acceptable to increase intensive in-home workload by 50% with no raise, it is a slap in the face to our profession. It undermines the morale of workers and marginalizes the good work that we do.

We must turn to each other in these situations. Let’s all watch what the NC-NASW does and keep one another informed about what agencies decide to do. We may not have backup but we do have each other.

Please let’s connect with one another for support. Share this with others or talk about how you feel by leaving a comment below.





  1. Dr. Christopher Hall, PhD, LCSW  October 4, 2014

    Yes, I did notice that the reimbursement rate is going down 1% but I am not so concerned about that because the agency owners are still doing fine. Intensive In-home is profitable on the backs of good counselors.

    • Lauren D. Neal  December 21, 2015

      LPCs as well. LCSWs, LPCs, and MFTs should get together and collaborate on putting our feet down and demand respect….and sufficient money to pay back student loans. We whom accept Medicaid clients should get tuition reimbursement, if not raises (that way business owners can’t nab the benefit for themselves). There is a lack of fight among many of us in the helping fields, perhaps, because everyone has tons of paperwork and are too tired to take extra steps to protect ourselves.

  2. Angeladiume  January 13, 2017

    You always do the right thing. God Bless you.
    Thank you

  3. Juliecoamn  January 13, 2017

    Good post! I read your blog often and you always post excellent content. I posted this article on Facebook and my followers like it. Thanks for writing this!


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