Federal Budget

Budget and Appropriations  

The Labor, Health and Human Services, Education, and Related Agencies Appropriations (LHHS) bill funds almost all disability programs. A continuing resolution was passed on September 29, which extends funding for the federal government through December 16. Congress is now working to try to come to an agreement and complete the budget before the end of the year.

NCCDD is advocating for several funding adjustments in the end of year package including:

• Increased asset limits for people receiving Supplemental Security Income (SSI): This would allow people to save for emergencies instead of being forced to live in poverty. The asset limit has not been updated since 1989.
• Make the Money Follows the Person (MFP) program permanent: The program assists people with disabilities and seniors in returning to their homes after spending time in a nursing facility or congregate setting. This program has already helped over 100,000 people return to their homes with the help of community-based services, but has not established permanent funding to maintain long-term operations.
• Increase ABLE age cutoff from 26 to 46: ABLE accounts allow for people with disabilities to accrue and save money for long-term care without the risk of losing federal benefits such as Supplemental Security Income (SSI) or Medicaid. However, this benefit is currently reserved for people to utilize until age 26. NCCDD advocates for an age increase to 46 so that people with disabilities can continue to save for their futures.
• End the use of electric shock treatment at the Judge Rotenberg Center (JRC) in Massachusetts: JRC is the only place in the country where it is permissible to use electric shock therapy on people with disabilities. The practice has been known to be abusive and ineffective.

Plain Language : The fiscal year runs from October 1 to September 30 each year. The Senate Democrats have released their funding (budget) bills for the 2023 fiscal year. The House of Representatives has passed its bill through the Committee. The House of Representatives and Senate did not finish the budget work by the deadline of October 1, so an extension has been given until December 16. The House and Senate are working to finalize the budget before the end of the year. NCCDD hopes the budget will include additional funding for I/DD supports and services.

Update on Electric Shock

Congress Fails to Block Use of Shock on Residents With Disabilities at Judge Rotenberg Center (JRC):  Congressional leaders passed a bill to fund the Food and Drug Administration for another five years. Unfortunately, this bill did not include the ban on the use of electric shock devices for behavior modification on people with disabilities. The brutal treatment is widely recognized as cruel, harmful and ineffective. Yet, the JRC, an institution in Massachusetts for people with intellectual and other developmental disabilities (I/DD), still subjects its residents to the extreme practice.

After years of tacitly endorsing the only facility in the country known to use electric shocks to address behavior in those with I/DD, a major behavior analysis organization is coming out against the practice. The Association for Behavior Analysis International (ABAI) voted this week to adopt a position statement explaining: “...we strongly oppose the use of contingent electric skin shock (CESS) under any condition.”

Plain Language:  There is a center in Massachusetts that uses electric shock on people with disabilities. Advocates are trying to get Congress to pass a law to terminate the practice. A national behavior analyst group has also come out against the use of electric shock after pressure from self-advocates.

State

Legislature – The Long Session begins in January. One of the primary tasks of the session is to pass a two-year budget for July 2023-2025.  The previous two-year budget from July 2021-June 2023 included additional waiver slots, increased wages for direct support professionals, and some adjustments to special education funding. This was only a start for addressing the significant needs in the I/DD system and NCCDD hopes to see additional allocations directed toward meeting the many unmet needs of the community.

There was hope that an agreement on Medicaid expansion would be reached after the election.  At this point, it seems there will be no vote on Medicaid expansion in December.  This issue will be readdressed in the Long Session and a new bill will have to be drafted.

Plain Language: The NC legislature will start meeting again in January to work on a two-year budget. Advocates will be working to ensure the budget includes funding for I/DD services.

Division of Mental Health, Developmental Disabilities, and Substance Abuse Services (DMHDDSAS) Update

Two key leadership positions in the DMHDDSAS have been filled. Effective December 19, 2022, Kelly Crosbie will serve as Division Director for DMHDDSAS and Renee Rader will serve as Deputy Director.

Crosbie has worked for multiple non profit organizations that support individuals with I/DD. Her positions have ranged from chief quality officer for NC Medicaid DHHS to chief strategy officer for Monarch to chief operating officer for Community Care of North Carolina. In each setting, her work was dedicated to promoting greater self-determination and equity. From 2008-2012, she served as the assistant director for Behavioral Health and Intellectual and Developmental Disabilities at NC Medicaid where she oversaw benefits such as the Innovations Waiver. And in 2013, she was named NC Medicaid’s chief operating officer. Most recently, Kelly served as the chief quality officer for the Division of Health Benefits (formerly NC Medicaid).

Radar joined the North Carolina Department of Health and Human Services (NCDHHS) in 2011 to expand her impact. Since then, she has led policy and program development in NC Medicaid and DMHDDSAS. As a lead consultant in I/DD, she was instrumental in developing and implementing the Innovations Waiver. Most recently, Renee served as the assistant director for Policy and Programs at DMHDDSAS.

With nearly 60 years of combined experience, Crosbie and Radar have dedicated their professional careers to making a difference in the lives of people with I/DD and improving services for people seeking mental health, substance abuse, and/or disability support. NCCDD congratulates Crosbie and Radar and looks forward to working with them.

Plain Language: There are two new staff in the disability state agency. The new division director of DMHDDSAS is Kelly Crosbie and the new deputy director is Renee Radar. Both individuals have substantial experience working with people with I/DD.

Division of Vocational Rehabilitation Services (DVRS)

DVRS received a $13.8 million five-year federal grant to assist community rehabilitation programs to move from sub-minimum wages to competitive integrative employment (CIE). The grant is in the early stages and will begin with three pilot locations across the state.

Samantha R., et al. v. North Carolina and the NC Department of Health and Human Services

November brought a landmark ruling in the Samantha R. Case. A judge upheld the Olmstead decision and ruled that the State of North Carolina needed to create measurable goals to support people with disabilities in the following areas:

• Within 10 years, the State must provide services to the 16,314 people currently on the waiting list for an Innovations (Medicaid) Waiver.
• The State must effectively address and resolve the serious shortage of Direct Service Professionals (DSPs) who provide community-based support.
• The State must assist 3,000 people who want to leave or avoid institutional settings and cease new admissions to institutions after 6 years. This is in exception to respite or short-term stabilization.
• The State must provide quarterly reports about each measure the judge set forth and post data to its website so that the public may receive timely information regarding the State’s progress. The state must also report this information to Disability Rights NC and the judge to allow for verification and tracking.

Though the ruling validated the significant need for more community services and supports for people with disabilities in North Carolina, the NCDHHS appealed the decision only weeks later. The appeal has generated a great deal of debate and discussion among various stakeholders in the field. NCCDD remains committed to working with policy and legislative leaders to ensure that people with I/DD have true choice for their personal care. NCCDD will continue to advocate and raise awareness for the urgent, unmet needs of the I/DD community.

Tailored Plan

Medicaid’s Tailored Plan rollout was pushed back to April 1, 2023. The integrated health Medicaid Benefit Plan aims to support people with I/DD as well as those with significant mental health or substance abuse disorders. The delayed start will allow the Local Management Entity/Managed Care Organizations (LME/MCOs) extra time to develop a more robust network of healthcare providers for about 150,000 Medicaid enrollees.

However, Tailored Care Management (TCM) will be implemented before the Tailored Plan and will occur based on the following timeline:

• December 1, 2023*: Tailored Care Management rollout begins.
  • *NOTE: the implementation of 1915(i) services set to begin December 1, 2022 has been delayed pending approval by federal regulators.
• January 15, 2023: Tailored Plan auto-enrollment and information mailing to enrollees starts.
• January 15, 2023: Tailored Plan Choice Period begins – Tailored Plan members can choose a TCM organization as well as a primary care provider (PCP) if they have not already done so.
• February 14-15, 2023: The choice period ends and auto-assignment begins for enrollees/members who have not chosen a primary care doctor and/or a care management provider.
• February 17, 2023: Tailored Plan members can begin requesting non-emergency Medicaid transportation services for appointments on or after April 1, 2023.
• April 1, 2023: Tailored Plan services begin.

For more information, visit the NC DHHS webpage on Tailored Plans.