This Just In!

The following important events occurred after the original writing of the Public Policy Update. 

NC Budget Update: 

The budget was released on November 15th and was voted on by both chambers later that week.  The Governor signed the budget on November 18th. Below are highlights related to priorities of the NC Council on Developmental Disabilities. A more detailed update will be provided in the next HHT. 

• Funding Direct Care Worker Rate Increase: Intent to get wages up to $15 per hour.
• Direct Care Worker One Time Bonuses of $2,000.
• 1000 Innovation Waiver Slots.
• 114 CAP/DA slots.
• ICF/IDD Worker Rate Increase.

Federal Update: 

The infrastructure bill was passed by the House and on November 15th President Joe Biden signed the $1.2 trillion infrastructure bill into law. It will deliver $550 billion of new federal investments in America's infrastructure over five years, touching everything from bridges and roads to the nation's broadband/internet, water and energy systems.

The Build Back Better bill was approved by the House on Friday, November 19th. It now goes to the Senate where it will face more scrutiny and possible changes.

STATE UPDATE

Legislative

Over the past few weeks, the legislature’s attention was on redistricting. The new maps for NC Congressional representatives and state representatives and senators have been approved. The General Assembly has not yet finalized a budget. Areas of discussion about the budget have included Medicaid expansion, taxes, and state employees’ and teachers’ salaries. The lack of budget may have impacts on other initiatives in NC, including the Tailored Plan and the development of Care Management for people on the Tailored Plan. We are also anticipating that 1,000 Innovations Waiver slots and increases in Direct Support Professionals’ wages to be part of the budget. There is a possibility that we will see ‘mini budgets’ to address some of these critical issues if a state budget is not passed soon.

NC Plan for Implementation of Federal Funds from the American Rescue Plan Act (ARPA)

The DHHS submitted a proposal to the Center for Medicare and Medicaid Services (CMS) and how NC will spend these federal funds. The plan included some items that are critical to the Council’s priorities. 

• Waiver Expansion and Waitlist Reduction
• Home Health Expansion for people with complex medical needs
• Expand Research-Based Behavioral Health Treatment for autism
• Unified Waitlist Project 

The plan has received tentative approval from CMS, but there are some clarifications requested by CMS. DHHS is working on a response to CMS. These funds are linked to  items in our state budget, such as Innovations Waiver slots and the Home and Community Based Services (HCBS) Fund that was proposed in the House budget. 

Tailored Plans 

A critical part of Medicaid transformation is Advanced Medical Home Plus (AMH+) practices/Care Management Agencies (CMAs), which will provide coordination and support for people enrolled in the Tailored Plans. The DHHS is in the process of approving agencies as AMH+ practices/CMAs. These agencies will offer a “multidisciplinary care team to provide whole-person care management that addresses all of their needs, spanning: physical health, behavioral health, I/DD, traumatic brain injuries (TBI), pharmacy, long-term services and supports (LTSS), and unmet health-related resource needs.”   This is obviously an important support in the Tailored Plan. The DHHS has created a Tailored Care Management Technical Assistance Group (TAG) to provide input into how this service should be developed and delivered. The TAG includes advocates and providers and is an open meeting. The links to the meetings are:

• Friday, Nov. 19 3 to 4 p.m. Join the Teams meeting
• Friday, Dec. 17 3 to 4 p.m. Join the Teams meeting
• Friday, Jan. 28 3 to 4 p.m. Join the Teams meeting
• Friday, Feb. 25 3 to 4 p.m. Join the Teams meeting
• Friday, March 25  3 to 4 p.m. Join the Teams Meeting
• Friday, April 22  3 to 4 p.m. Join the Teams Meeting
• Friday, May 27   3 to 4 p.m. Join the Teams Meeting
• Friday, June 24  3 to 4 p.m. Join the Teams Meeting 

For more information, below is a link to the TAG webpage. 

Tailored Plans are scheduled to launch on July 1, 2022. There are factors that may influence the start date, including a lack of a state budget and the development of Care Management. A third factor is the development of HCBS through 1915(i) funding. As mentioned in the last Highlights and Hot Topics, NC is working on developing a State Plan HCBS benefit. The plan is to transition the current B(3) services (such as community living, respite, supported employment) into 1915(i). The state is in the process of developing policies around eligibility, services provided, and any limitations. This is important because it would allow Medicaid-eligible people to access community supports without being on the Innovations Waiver. The timing of CMS approval and development of state policies is critical as 1915(i) needs to launch at the same time as the Tailored Plans. 

Olmstead Plan – A draft of the Olmstead Plan was released on October 12. The state received feedback through November 8, and the final plan is scheduled to be released in December. The purpose of the Olmstead Plan is to create a clear plan for enhancing access to appropriate community-based services and supports for people with disabilities in NC. The goal of the plan is to create a path forward to ensuring that people with disabilities can live full lives in their communities. 

The NCCDD submitted feedback which highlighted some of the concerns about the draft Olmstead Plan that have been expressed from self-advocates, advocates, families, and other stakeholders. View the feedback here.

Expanding Opportunities for Competitive Integrated Employment

After considerable input and work from many stakeholders – including the NCCDD -- the State recently announced a 5-year initiative to enhance opportunities for employment for people with disabilities. The initiative will include:

• Align employment services with best practice
• Engage stakeholders to understand new services
• Informed choice awareness campaigns
• Trainings for providers, families, advocates

The goal is for people to be in Competitive Integrated Employment in the community, earning at least minimum wage. Read more here.

FEDERAL

At the federal level, there have been two major funding bills that have been discussed over the past several months: Infrastructure and Build Back Better. The Infrastructure includes investment in things like roads and internet, while the Build Back Better includes investment in people like preschool, housing, and health care. 

Congress recently passed the $1.2 trillion Infrastructure bill. Key parts of the bill include:

• $39 billion to modernize public transit, upgrade aging infrastructure, and make stations accessible. 
• $65 billion to ensure access to high-speed internet for all.

Congress continues to work on legislation as part of the budget reconciliation, or Build Back Better Agenda, that could greatly affect the lives of people with disabilities and their families. The original $3.5 trillion plan has been cut to $1.75 trillion. It still includes child care tax credit, fighting climate change and reducing prescription drug costs. Paid leave and vision/dental coverage seem to be out of the package. Importantly for people with disabilities, it continues to include expansion in Medicaid home and community-based services (HCBS):  

• $150 billion for Medicaid home and community-based services