FEDERAL

Health
As part of the Medicaid Services Investment and Accountability Act of 2019 (H.R.1839), the ACE Kids Act became law. The law will expand access to patient-centered pediatric-focused coordinated care models tailored for medically complex kids.

On May 1, bipartisan cosponsors in the House introduced the Healthcare Extension and Accessibility for Developmentally Disabled an Underserved Population Act (H.R.2417). This bill would declare people with DD as a medically underserved population, a designation that comes with access to 25 government programs.

Also, 16 democratic cosponsors in the House introduced the Medicare for America Act (H.R.2452). The bill would expand Medicare to cover all persons not covered by employer-sponsored health plans.  Another notable component of the bill would expand Medicare benefits to include long-term services and supports, something that’s currently only available through Medicaid.

Education
The Government Accountability Office released a report documenting the differences between states in rates of eligibility for services under the Individuals with Disabilities Education Act (IDEA), ranging from 6.4-15.1%. The range is attributed to the flexibility given to states by law. The report also notes difficulty identifying English language learners with disabilities due to a lack of staff who are fluent in the student's native language.

House and Senate members jointly introduced the Keep Our Promise to America's Children and Teachers Act (S.1172/H.R.2315), which gradually increases funding for Title I of the Elementary and Secondary Education Act and special education (Part B, the State Grant Program) under IDEA until both are funded at authorization levels.

ABLE Account Guidance
The US Department of Housing and Urban Development recently issued long-awaited guidance clarifying that funds in ABLE accounts should not be included in determining a person's eligibility for means-tested housing assistance.

Budget and Appropriations
On May 8, the House Appropriations Committee approved its Labor, Health and Human Services, Education and related agencies bill for fiscal year (FY) 2020 with overall funding of $189.9 billion, a 7% increase from last year. The Arc of US compiled a detailed list of funding levels. Despite progress in the House, Senate appropriators signaled they will not move forward until a deal is reached to increase spending caps on discretionary programs. Without a unified agreement, all non-defense discretionary programs will face a 9% reduction due to the Budget Control Act of 2011.

DD Act programs
On May 5, the Administration on Community Living (ACL) announced a proposed reorganization that would split oversight of DD Act programs, DD Councils and University Centers for Excellence in Developmental Disability separate from Protection and Advocacy Centers.

STATE

Budget – The General Assembly is in long session with a major task being the biennial budget.  At this point, the House has approved its budget and sent it to the Senate. The Senate is working on their budget and is expected to approve it in the next few weeks. Highlights of the House budget include:

• Medicaid Transformation Reserve: Funds from the Medicaid Transformation Reserve of the State General Fund to pay claims during the transition to managed care. Funds for the Ombudsman Program and the Enrollment Broker are also included here.
• Expanding Innovations Waiver by 150 Slots:  NC DHHS will amend the North Carolina Innovations waiver to increase the number of slots by 150. We are hoping to see more in the Senate budget.
• Traumatic Brain Injury Funding set to $2.3 million recurring each fiscal year of the biennium
• ICF “In Lieu of” Service: This service definition uses community-based supported living as an alternative to an ICF residential setting.
• Supplemental Short-Term Assistance for Group Homes fills a gap created when people with I/DD lose funding due to eligibility changes to Personal Care Services.
• Single Stream Funding Cut Change:  Revises and decreases the recurring reductions made previously to LME/MCOs. This revision actually increases funding to each LME/MCO.
• Group Home (GH) Wages:  Increases the capitation rates for LME/MCOs, effective January 1, 2020, to enable increases in the wages paid to direct support personnel (DSP) working in GHs for individuals with I/DD. While we support increased wages, we would like to see increases for all DSPs, not just those in GH settings.

*These are all only in the House budget.  Once the Senate approves their budget, the standard process is to have the differences in the two budgets resolved with a Conference Committee.

Bills – Several bills met the crossover date (a bill has to pass through either the House or the Senate by a certain date to be eligible for action during the session). Below are two that are of interest and expected to pass both chambers.

HB 619 (PASSED HOUSE) - An act to establish a Rethinking Guardianship Workgroup to study and recommend changes to current guardianship statutes. This is in line with the work the Council has been doing related to guardianship. Expected to move through the Senate.

S556 GSC (PASSED SENATE) - The People First Language (PFL) 2019 bill updates statutes relating to the provision of services with PFL by changing the phrase "mental retardation" to "intellectual disability" or "intellectual or other developmental disability.” Moving through House.

Medicaid Transformation continues to move forward with Standard Plan expected to launch in November.  The Department of Health and Human Services (DHHS) is working with the Prepaid Health Plans (PHPs) on the development of their networks of providers.

The Tailored Plan (TP) is projected to launch in July 2021. There was a recent white paper on Eligibility for the Tailored Plan and on Care Management.

Key Points:

• Notification of changes to Medicaid with be sent to individuals/families. One letter will be sent to Head of Household saying there is a new way that Medicaid will be managed and it will describe the different situations for each family member. This is an improvement over an initial plan to send individual letters to each Medicaid recipient.
• There are identified variables that create an assignment to Tailored Plan (Innovations recipients, people on the waitlist, people receiving state-funded services, etc). There will be a way for an individual who is not initially assigned to request the Tailored Plan. The assessment for this will be conducted by an independent vendor.
• Once someone is eligible for the Tailored Plan, it should be simple to go in and out of the TP if needed.
• Enrollment Broker website should be up by June 28.  DHHS is working with Maximus on notices, flyers, posters, social media, etc.
• There were no responses to Omsbudsman RFP due to restrictions on who could apply.  DHHS got feedback from potential bidders and is revising the RFP and will issue it soon.  This is critical for people to have an advocate.