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Public Policy Update - January 11, 2023

Public policy update


Legislative Budget Process 

The Long Session begins in January. One of the primary tasks of the session is to pass a two-year budget for July 2023-June 2025.  

Review of Budget Process – The budget process has already begun. Below are main steps in the process:

1)    The Governor's office receives budget proposals from all state departments in late fall/early winter. 

*The Department of Health and Human Services has developed a proposed budget to send to the Governor’s office. Priority areas related to people with I/DD include: DSP wages, Innovations Waiver, crisis initiatives, competitive integrative employment, increased rates for behavioral health services.

2)    The Governor receives the departments’ proposed budgets, reviews and edits proposals, finalizes a state budget and submits to the General Assembly in January or February. 

3)    First chamber of legislature – this year the House – creates, prepares and passes a proposed budget. The budget is sent to the other chamber (Senate). 

4)    The Second Chamber (Senate) can either concur/agree with the budget and vote to enact OR more commonly create a substitute budget bill and pass it back to the first chamber (House).

House and Senate Chambers each operate “Full” Appropriations Committees.

  • Chairs are appointed for each chamber’s Full Appropriation Committees (Full Chairs) and for each subcommittee (Subcommittee Chairs): 
  • Full Appropriation Committees are divided into subcommittees organized around functional areas of State government.
      • Health and Human Services  
      • General Government
      • Education 
      • Transportation
      • Justice and Public Safety 
      •  Natural and Economic Resources 

There is rarely agreement between the House and Senate after this process. Typically a Conference Committee will be appointed to resolve the differences between the two budgets.

5) The Conference Committee works to resolve differences, and a Conference Report is eventually adopted by each Chamber and an Appropriations Act is ratified.  

6) The ratified Act is sent to the Governor for signature, after which it becomes law. 

*Exception: The Governor can veto the Appropriations Act and set into motion a veto override scenario. 

NCCDD will be monitoring this budget process and engaging with policy makers about critical needs related to the waitlist such as Innovations Waiver and direct support professional wages. 

Plain Language: The NC legislature will start meeting again in January to work on a two-year budget. The budget process includes many steps before it is final. Advocates will be working to make sure the budget includes money for services for people with disabilities. 

Medicaid Expansion 

While there was disappointment that Medicaid Expansion was not passed during this past session, there seems to be an openness from legislators for it to be on the agenda this session. Medicaid Expansion is a priority for the Department of Health and Human Services. 

*The Families First Coronavirus Response Act in March 2020 offered states enhanced federal funding for their Medicaid programs. In exchange, states were required to provide continuous coverage to those enrolled. The provisions were tied to the COVID-19 public health emergency (PHE). The new law ends the enhanced funding and continuous coverage requirement starting March 31, 2023. Starting April 1, 2023, North Carolina will have to begin redeterminations for Medicaid enrollees. This makes it even more important that Medicaid Expansion is passed quickly because there will be many people at risk for losing Medicaid eligibility. 

Plain Language: Advocates will be asking legislators to consider Medicaid Expansion.  Medicaid Expansion would help many people in NC receive services and supports. 

Tailored Plan

The start of the new Tailored Plans, integrated health Medicaid Benefit Plans for people with intellectual and/or developmental disabilities (I/DD), as well as those with significant mental health and substance use disorders, was delayed until April 1, 2023, to give the LME/MCOs more time to develop networks of health care providers for about 150,000 Medicaid enrollees. The LME/MCOs are undergoing readiness reviews to determine if there has been progress on the network development. An announcement from DHHS regarding the timeline for implementation of Tailored Plans is expected in late January or early February.

Plain Language: The new way for managing services and supports for people with disabilities called Tailored Plans is supposed to start April 1, 2023. The state is working to make sure the plans are ready to begin and will let people know if the start date needs to change. 




On December 23, 2022, Congress passed a fiscal year 2023 Omnibus Appropriations Bill. This federal spending bill of $1.7 trillion included over $15 billion for special education, a $904 million increase over last year, and it extended Money Follows the Person (MFP) through 2027. MFP is a Medicaid program that helps people with disabilities move from institutional settings to community-based living. Other items include:

  •  ABLE Age Adjustment Act – This act increases the age of disability onset to access an ABLE account from age 26 to age 46. The change becomes effective in 2026. ABLE accounts are generally exempt from counting as a resource for public benefits but are capped at $100,000 for purposes of Supplemental Security Income (SSI). ABLE accounts can be funded by up to $17,000 in 2023.

  • Special Needs Trust Improvement Act – This act makes a technical change to the tax code that makes it easier to allow a charity to be a remainder beneficiary of a special needs trust that inherits a retirement account.

  • Ban Electroshock Devices – The legislation included language that creates a pathway to ban the use of electroshock devices used by the Judge Rotenberg Center. While the legislation does not specifically ban the torturous device, it does create a pathway for the Food and Drug Administration to issue a new ban on the device and have the ban upheld in court.

Plain Language: Congress passed a budget bill to provide funding for programs across the country. There was money included that will help people with disabilities. More money was put in schools for special education, money was included for programs to help people with disabilities live in the community, and new laws will help people with disabilities earn and save more money.


Supplemental Security Income 

Individuals with disabilities receiving Supplemental Security Income and other Social Security benefits are seeing the largest rise in their monthly payments in decades. With the new year, benefits are up 8.7 percent, according to the Social Security Administration. As a result, the maximum federal SSI benefit for this year is $914 per month for individuals and $1,371 for couples, the agency said, though payments can be higher since some states kick in extra. The jump comes as a result of an automatic cost-of-living adjustment, known as COLA.

Notably, however, Congress did not include increasing asset limits for Supplemental Security Income recipients within the new budget. Currently, individual SSI beneficiaries can have no more than $2,000 in assets at any given time under limits that have remained static for decades. Advocates will continue to push for an increase in the asset limits. 


Plain Language: People with disabilities who receive Supplemental Security Income (SSI payments) will get more money in their checks starting January 2023.



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North Carolina Council on Developmental Disabilities

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This project was supported, in part by grant number 2001NCSCDD-02, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects with government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official ACL policy.

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