State

Legislative Budget Process – The Long Session has begun. One of the primary tasks of the session is to pass a two-year budget for July 2023-June 2025.  

In the last Highlights and Hot Topics issue, we discussed the budget process. The first official step is the Governor’s budget, which is based on input from the various departments of state government. The Department of Health and Human Services (DHHS) developed a proposed budget, which was sent to the Governor's office for review. The budget prioritized areas that affect people with I/DD including Direct Support Professional (DSP) wages, Innovations Waiver accessibility, crisis initiatives, competitive integrated employment (CIE) expansion, and increased pay rates for behavioral health services.

The Governor’s budget is expected to be sent to the legislature in early March. Once it has been released, the selection of DHHS priorities will be revealed. 

In the meantime, the legislature is getting to work. The Appropriations Committees in the House and Senate will lead budget development. It is critical that these legislative bodies educate the committee chairs and members about people with I/DD and their needs.

•       NC Senate HHS Appropriations Committee

–      Sen. Jim Burgin (Chair)

–      Sen. Joyce Krawiec (Chair)

–      Sen. Kevin Corbin (Chair)

•       NC House HHS Appropriations Committee

–      Rep. Larry Potts (Chair)

–      Rep. Kristin Baker (Chair)

–      Rep. Donna White (Chair)

Advocacy Efforts for I/DD Priorities

NCCDD is active in educating members of the legislature about the needs of people with I/DD. As a reminder, NCCDD’s priorities are to: 

1.      eliminate the waiting list within eight (8) years and to meet the needs for everyone on the 16,000-person waiting list;

2.      increase DSP Rates to a minimum of $18.00 per hour in order to ensure a sufficient direct care workforce;

3.      expand integrated, affordable and accessible housing options for people with I/DD in North Carolina;

4.      increase competitive integrated employment (CIE) opportunities for all individuals with I/DD; and  

5.      improve access to I/DD home and community-based services through the successful implementation of the Tailored Plans, care management and 1915(i). 

NCCDD shares values and priorities with other organizations, including The Coalition. The Coalition is composed of statewide organizations in North Carolina that are committed to assuring the availability of services and support for individuals who experience addictive diseases, mental illness and developmental disabilities. 

The Coalition’s proposed budgetary priorities for legislation, include:

• $87 million recurring: Increase wages for direct support and peer service providers by 35% in order to attract and retain employees. Raise the lowest DSP pay rate to $18.00 per hour. Develop plans to accommodate economic changes and increased labor costs. 
• $48 million recurring: Increase access to the Innovations Waiver by 2,000 slots per year to reduce the waitlist. 

• $250,000 recurring: Expand affordable housing options for persons with disabilities. Create a state Office of Housing to develop and coordinate a comprehensive strategy around housing for people with disabilities.  
• $300,000 recurring: Develop reentry initiative for people with I/DD who are leaving prison. Implement Medicaid suspension program for people in county jails. 
• $400,000 recurring: Extend community organization funding to support non-clinical, crucial determinants of health provided by family and natural supports, as well as services not covered by Medicaid.
• Develop service definitions that increase family support, such as "coordinated caregiving,” “personal assistance,” or other options to Innovations Waiver programs and 1915(i) services. 
• Fund access to services for children with complex needs through care management, NC START, and I/DD medical health home pilots.
• Utilize the Tax Equity and Fiscal Responsibility Act (TEFRA) waiver to fund Medicaid for complex children.
• Close the health insurance gap by enacting Medicaid expansion to cover services for 500,000 individuals.  

NCCDD will be monitoring this budget process and engaging with policymakers to provide education regarding these items. 

Plain Language: The NC legislature is meeting again 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. 

Tailored Plans

The start of the new Tailored Plans, an integrated Medicaid benefit plan for people with I/DD and/or significant mental health and substance abuse disorders, was delayed until April 1, 2023. The delay was established in order to give the Local Management Entity/Managed Care Organizations (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 their progress. DHHS is expected to announce the timeline for implementing Tailored Plans in early February. 

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

Federal

Budget – On December 23, 2022, Congress passed a 2023 fiscal year Omnibus Appropriations Bill. This $1.7 trillion federal spending bill included several items related to I/DD. This included:

• A $904 million increase for Special Education
• Money Follows the Person (MFP) program, which helps people with disabilities move from institutional settings to community-based living, extended through 2027. 
• ABLE Age Adjustment Act extended access of disability onset to obtain an ABLE account from age 26 to age 46 starting 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 changed the tax code to make it easier for a charity to be a remainder beneficiary of a special needs trust that inherits a retirement account.
• Legislation included language that creates a pathway for the Food and Drug Administration to ban the use of electroshock devices used by the Judge Rotenberg Center 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, programs to help people with disabilities live in the community, and new laws that will help people with disabilities become more self-sufficient with their money.

Supplemental Security Income

Individuals with disabilities receiving Supplemental Security Income (SSI) 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%, 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, though payments can be even higher depending on state-specific funds. The jump comes as a result of an automatic cost-of-living adjustment known as COLA.

Notably, however, Congress did not include an asset limit increase for Supplemental Security Income recipients in the new budget. Currently, individual SSI beneficiaries can have no more than $2,000 in assets at any given time. 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. 

188th Session of Congress

 As the new session of Congress begins, the budget and appropriations process for the 2024 fiscal year begins. There have been leadership changes in both the House and the Senate, which will affect employment, healthcare, education, and other policies impacting persons with disabilities. Senator Bernie Sanders (I-VT) has taken over as the chairman of the Senate Health, Education, Labor, and Pensions Committee while Senator Bill Cassidy (R-LA) has been seated as its ranking member. In the House of Representatives, Representative Virginia Foxx (R-NC-5) has become the chair of the Education and Workforce Committee and Representative Bobby Scott (D-VA-3) continues as the Ranking Member. 

Senators Bob Casey (D-PA) and Debbie Dingell (D-MI-6) introduced the Better Care Better Jobs Act, which would enhance funding and expand access to services, provide a 10% increase in Medicaid match funding for delivering Medicaid home and community-based services, encourage innovative models that benefit direct care workers and care recipients, establish permanent Spousal Impoverishment Protections, and Make the Money Follows the Person Rebalancing Demonstration permanent.

This bill has only been introduced and has not passed the Senate, but indicators suggest that there is continued interest in increasing community services and supports for people with I/DD. 

Plain Language: A new session of Congress started in January to plan for the 2024 fiscal year. Some legislators are working to get more money for people with I/DD in the new budget. 

Other Federal Policy

On January 18, the Interagency Autism Coordinating Committee (IACC) voted to approve a new strategic plan. The plan provides recommendations to the Secretary of Health and Human Services on autism research and services. Under the Autism CARES Act, the IACC is supposed to update its strategic plan each year, but it has not been updated since 2019. You can read the full plan here.

 Plain Language: A committee that works to improve services for people with autism has approved a new plan. The new plan provides ideas about autism research and services to federal government agencies.