FEDERAL

President’s Budget

On Friday, April 9, 2021, the Office of Management and Budget (OMB) released an overview of the President Joe Biden’s appropriations proposals for Fiscal Year (FY) 2022 discretionary funding and some further details on priorities within individual agencies. 

The President's proposal is a 16% increase in non-defense discretionary spending over FY 2021, and includes several lines of interest to the disability community:

• Education
  • ~$15.5 billion for the Individuals with Disabilities in Education Act (IDEA) (+ $2.6 billion)
• Health and Human Services: 
  • ~$8.7 billion for Centers for Disease Control and Prevention (CDC) (+ $1.6 billion)
  • ~$51 billion for National Institutes of Health (NIH)
  • ~$551 million for Home and Community-Based Services (HCBS)

• Social Security Administration: 
  • ~$14.2 billion (+ $1.3 billion)

The President's budget is typically considered an opening bid in negotiations with US Congress. 

Infrastructure

President Biden released the American Jobs Plan, a proposal for infrastructure reform and economic recovery. The proposal is a framework that will need to be translated into legislative text and passed through Congress. Priorities in the disability community that may be considered as part of the legislative package include:

• Ending subminimum wages and modernizing disability employment supports to allow for competitive, integrated employment;
• Continued expansion of access to HCBS for people with disabilities, ending waiting lists for services and ensuring a stable, valued direct support workforce;
• Meeting the educational needs of students with disabilities in PreK-12 and higher education; and
• Ensuring all modernization of physical and virtual infrastructures are accessible (Infrastructure means the buildings, roads, bridges, power lines, and other things our country needs to work every day. It can also include systems that make our country work like schools, healthcare, and other government services.)

State Update

Governor Roy Cooper released his proposed two-year budget which calls for spending $27.4 billion in the first year, eight percent higher than his 2019 proposal, and which includes Medicaid Expansion and pay raises for teachers and other state employees.  

The following are items from the proposed budget that are related to people with I/DD: 

• Funds for 520 Innovations waiver slots 
• 60 million to address direct care and early childhood workforce issues (workforce funds are across children, aging and disabilities)  
• 30 million for increased housing and employment for people with disabilities 
• 10 million in funds for individualized early intervention  
• 305 million for resources for at risk children, including special education (removes funding caps, increases allocations)
• 5 million for reducing the implicit bias of students of color and students with disabilities in early education 
• 5 million for transportation through the Rural Operating Assistance Program (ROAP) which supports transportation for those with disabilities (these were the funds that were cut last year). 
• Funds for benefits counseling, and adaptive equipment through Vocational Rehabilitation. 

The release of the Governor’s budget was the first step in the budget process. The Senate is now working on their budget. Once the Senate passes a budget, it will be sent to the House where their budget will be approved. A conference committee will be appointed to work out differences. 

Bills that may impact people with I/DD:

HB 249 Children with Disabilities Funding Formula: HB 249 would direct the Department of Public Instruction to study the funding formula for children with disabilities and special education in public schools and consider a model that would base funding on the severity of disability. The bill also increases the cap on the current funding formula for children with disabilities from 12.75% to 13%. The study report would be due to legislative education committees by February 15, 2022.  

The funding formula for special education has been a concern for a long time.  A plan to address this could improve education supports for children with I/DD. 

North Carolina Innovations Waiver Act of  2021:  Bills were filed in the House (H389) and Senate (S350) that would fund an additional 1000 Innovations home and community waiver slots, including 200 set aside for the development of a tiered waiver to support people with a lower level of need. The bill also requires NC DHHS to convene a stakeholder group to develop a ten-year plan to address the Registry of Unmet Needs, also known as those waiting for services.   

It is hoped that funding for 1000 Innovations waiver slots will be in the Senate budget when it is released. 

Reduce Regulations to Help Children with Autism: This bill (S103/H91) will allow behavior analysts to obtain NC licensure and provide services on their own. Both the House and Senate passed this bill and after the approval of some technical changes, it is expected to go to the Governor for signature. 

This legislation will increase access to early intervention for children with autism. 

Police Notice of Person with I/DD in Vehicle: This bill is a proposal at this point. It would direct the Division of Motor Vehicles to develop a designation for driver’s licenses that may be granted upon request to a person with an intellectual or developmental disability and to appropriate funds for that purpose. 

The Council is in discussion with bill sponsors about this proposed bill. 

Medicaid Transformation

Medicaid Transformation continues to move forward. The Standard Plan is scheduled to launch on July 1, 2021. Letters have been sent to beneficiaries who need to enroll in a plan. These integrated managed care products called Standard Plans will cover physical health, behavioral health and pharmacy services to many North Carolinians who receive their healthcare through Medicaid. The open enrollment is scheduled to run through May 15, 2021. 

• People who currently receive services through the Innovations Waiver, the TBI waiver, or non-Medicaid state funds will continue to receive their services and supports through the current system. They should not enroll in the Standard Plan as none of these services will be provided through the Standard Plan.
• People who are on the waitlist will not be assigned to the Standard Plan, but may choose to enroll in the Standard Plan if they feel some of the offered benefits may be helpful. They will not lose their place on the waitlist and can come back to the Tailored Plan. Again, if they are receiving any services through the LME/MCO, these will not be available in the Standard Plan. 

Behavioral Health I/DD Tailored Plans are specialized managed care focusing on the needs of individuals with significant behavioral health disorders, intellectual and developmental disabilities (I/DD), and traumatic brain injuries (TBI). These plans are scheduled to begin in July 2022 and will cover a more robust package of Behavioral Health, I/DD and TBI services compared to Standard Plans. The LME/MCOs submitted applications to provide these plans and the Department of Health and Human Services is currently reviewing these applications.