Public Policy Update - April 20, 2026

Read a summary of recent public policy updates that may be of interest to North Carolinians with intellectual and other developmental disabilities (I/DD). These updates are current as of April 20, 2026.

FEDERAL

President’s Budget

As part of the federal budget process, the President released a proposed budget for fiscal year 2027 in early April. It proposes increasing defense spending by over 40% and decreasing non-defense programs by $73 billion. As with last year’s proposed budget from the President, there are proposed cuts to disability programs. University Centers for Excellence in Developmental Disabilities (UCEDDs) would be eliminated. The Leadership Education in Neurodevelopmental Disabilities (LEND) Programs would be decreased by almost $20 million. State DD Councils and Protection and Advocacy agencies are proposed to receive only a small decrease. Like last year, there is also a proposed restructuring plan for Health and Human Services (HHS), which would eliminate the Administration for Community Living.

The President’s budget is not legislation, but it is required to be submitted each year. It provides insight into the Administration’s priorities. Last year, Congress rejected these cuts and also rejected the restructuring plan for HHS.

Appropriations

Congress has now begun the process of considering appropriations legislation for FY 2027. The House and Senate are expected to start drafting and marking up appropriations legislation in the coming weeks. The House has held hearings for agency leadership to talk about the President’s budget.

On April 16, 2026, HHS Secretary Kennedy met with the House Appropriations Committee. The topics of discussion included vaccines, and Medicaid and Medicare fraud. The Secretary defended the cuts to HHS that were in the President’s budget. He emphasized the idea that there is extensive fraud in Medicaid and Medicare. Most Republicans on the committee were supportive of the focus on stopping fraud, with specific attention to Home and Community Based Services (HCBS). Leading Democrats on the Committee said that Congress will not cut the funding that the President wants to cut.

Over the next few weeks, there will be more information coming from Congress regarding the budget as the House and Senate follow their budget processes. There seems to be less consensus this year about the budget, and coming to an agreement will take months. It is expected that there will be a Continuing Resolution in September before the start of the FY 2027 in October.

Reconciliation 2.0

As of April 20, 2026, the Senate is taking initial steps toward a "Reconciliation 2.0" bill to resolve a partial government shutdown and secure long-term funding for the Department of Homeland Security (DHS). Reconciliation is the process used last year to pass H.R. 1 which included the large Medicaid cuts. Reconciliation can be used for mandatory spending and only requires a simple majority (51 votes) instead of 60 votes.

The primary goal of this bill is to end the DHS shutdown and provide multi-year funding for Immigration and Customs Enforcement (ICE) and Border Patrol. Senate leadership has advocated for keeping the bill focused on DHS funding; however, some Senate members are pushing to include other items, including changes to Medicaid, Medicare, or SNAP.

President Trump has set a deadline set of June 1, 2026 for the passage of this bill. The first steps in this process are for the Senate and House to pass budget resolutions, which will outline the process for reconciliation. The goal is to have this complete by the end of April.

STATE

The NC General Assembly convened on April 21, 2026 for a short legislative session. The short session is typically focused on making minor budget adjustments and passing a small number of bills. However, during last year’s long session, NC lawmakers were unable to agree on a budget. The federal cuts to Medicaid and other state programs are creating pressure to approve a budget. Key issues related to the budget include whether to allow planned tax cuts to proceed, state employee salary increases, and the Medicaid funding shortfall for this fiscal year. There is concern that delays in the budget process could reduce access to services funded through Medicaid. Key House leadership has stated that they expect the legislature to approve funding to address the shortfall. The concerns about Medicaid fraud at the federal level are also being expressed at the state level, so there may be additional requirements for addressing fraud and the rising Medicaid costs that come with the funding.