Federal

Budget

Congress is in recess until September 12. The deadline for the budget is September 30.

As a reminder, the negotiations and deal agreed upon on the debt ceiling resulted in no major changes to Medicaid. However, the agreement includes spending caps that are likely to impact disability programs for years to come. The new limits on domestic spending over the next two years will affect a wide range of federal programs for people with disabilities. For example, freezing funding at current levels until 2025 effectively cuts spending on special education, housing, and vocational rehabilitation, and many other programs. This could affect state Councils on Developmental Disabilities as well.

Centers for Medicare & Medicaid Services (CMS)

CMS has proposed two rules related to Home and Community Based Services.

• Access Rule
  • Required to reassess the needs of each individual receiving home and community-based services annually and revise service plans.
  • At least 80% of what Medicaid pays for personal care, homemaker and home health aide services would be required to go directly to the person providing the support.
  • States would need to publish the average hourly rate paid to direct care workers.
  • Reports on waiting lists, reports on quality measures.
• Managed Care Access, Finance and Quality Rule
  • Require states to regularly survey managed care enrollees about their experiences.
  • Institute maximum appointment wait time standards.
  • Require states to conduct secret shopper surveys annually.

These rules were up for public comment through July. CMS will review comments and finalize rules by the first of the new year.

Plain Language:
The federal government has proposed two rules to improve services to individuals with developmental disabilities. The first rule would require most of the money from Medicaid Waivers to go to the caregiver (Direct Support Professional). The second rule would help people who have managed care.

State

Budget and Medicaid Expansion

Legislators were expected to deliver a budget by July 1. It appears that it might be mid-September before a budget is passed. Several items in the budget are critical to people with intellectual and developmental disabilities. The budget will include the final number of Innovations Waiver slots and the final amount for DSP raises; as well as funding for Medicaid that is critical for the transition to managed care.

Medicaid expansion is also tied to the budget passing. The Department of Health and Human Services (DHHS) recently announced plans to roll out Medicaid expansion on Oct.1, This is conditional on the budget passing by September 1 or authority from the General Assembly. This authority can be granted without a finalized budget, although it would require the passage of a separate bill which seems unlikely. DHHS continues to work toward the October 1 date for Medicaid expansion, while also acknowledging that it may be delayed.

Plain Language: The state budget is delayed. This is because the North Carolina House and Senate have not yet reached an agreement. There are many important items in the state budget that could help people with developmental disabilities. The budget must also be passed for Medicaid expansion to start.

Tailored Plan

The launch for the Tailored Plan has been delayed beyond the October 2023 date and no new date has been set. DHHS continues to work with LME-MCOs on building capacity in the provider networks. Access to physical healthcare and specialty care has been a concern expressed by many self-advocates and family members. This delay should allow more work on ensuring the networks include the services needed by people with I/DD.

Plain Language: Tailored Plans are delayed. There is not a start date for when they will begin. The delay will allow continued work to try to ensure people can keep their doctors and that there are enough doctors part of the plan.

1915(i)

The 1915(i) services became available on July 1. The initial focus has been on transitioning people who currently receive B3 services to 1915(i). Those who are in the Tailored Plan will work with their Tailored Plan Care Manager for assessment, authorization of services, and monitoring of service delivery. People who are not currently receiving services should reach out to LME-MCOs where a Care Coordinator can begin the assessment process.

Plain Language: 1915(i) is a new service for people with developmental disabilities and Medicaid. Talk to your Tailored Care Manager about obtaining this service.