Public Policy (as of October 25, 2023)

State

Budget

Some of the highlights of the budget include 350 Innovations slots, $60 million for DSP wage increases, funding to support competitive integrated employment, and funding for educational opportunities in the community colleges and universities. There are still great needs, and we had hoped for a more robust response to the waiting list and the DSP wages. The education and advocacy efforts of NCCDD and our partners will continue as we monitor the impact of this year’s funding and also focus on additional support to meet the needs. 

Medicaid Expansion

The Department of Health and Human Services (DHHS) received approval from the Centers for Medicare and Medicaid Services (CMS) for the launch of Medicaid Expansion on December 1, 2023. This means that more people ages 19 through 63 will now qualify for healthcare coverage through Medicaid. On December 1, close to 300,000 will automatically qualify and thousands more will be made eligible over time. It is estimated that more than 600,000 people in North Carolina will gain this coverage. DHHS has been preparing for this and continues to focus on being ready for the December 1 time frame.

NCDHHS launched a new website with a toolkit of resources for organizations to spread the word to their communities.

Tailored Care Management (TCM)

In response to feedback about the implementation of TCM, the Department of Health and Human Services formed a TCM Collaborative. The Department is working with Care Management Agencies (CMA), Advanced Medical Homes (AMH+), and the LME-MCOs to gather feedback on provider rates, assignment processes, and community awareness. Strategies are being developed for addressing barriers (including the rate structure), improving accuracy of data, and increasing awareness and education in the community. 

At the Council’s October Policy Education Committee, Gwen Sherrod from the Division of Health Benefits (DHB) provided an overview of TCM. Here is a link to the presentation slides.

Federal

House of Representatives Speaker Update

On Tuesday, October 3, the House of Representatives made a historic vote to remove Kevin McCarthy as the Speaker of the House. After McCarthy was voted out, Republicans held a vote for who would be the next Speaker. Steve Scalise won the vote against Jim Jordan by 14 votes. However, Scalise decided to remove his name for nomination a day later. Now, as of October 25, 2023, after three failed attempts to elect Jim Jordan, the House has sworn in Representative Mike Johnson as Speaker of the House. Federal legislative work is at a standstill. 

Budget

Since there has not been agreement on the federal budget, Congress enacted a continuing resolution on September 30 that allows funding to continue for the first seven weeks of fiscal year 2024. The new deadline for a budget is November 17. As a reminder, the funding in the new budget will have some limitations as a result of the agreement that was previously made on the debt ceiling. These caps on funding, the lack of leadership in the House, and the quickly approaching deadline for the budget create concerns about funding for several disability funding streams including for the Developmental Disabilities Councils.

Tracking Prevalence of Cerebral Palsy

For the first time in over a decade, the Centers for Disease Control and Prevention network that tracks the prevalence of autism is expanding to include another developmental disability. The agency said that five of its Autism and Developmental Disabilities Monitoring Network sites will start keeping tabs on the incidence of cerebral palsy in their communities in addition to autism. This will allow the CDC to track issues related to disparities in diagnosis and access to services. Collecting this type of information can lead to earlier diagnosis of cerebral palsy and access to early intervention. Earlier diagnosis can lead to increased availability of services and improved outcomes.  

Subminimum Wage 

As a result of rising pressure from disability advocates to stop allowing people with disabilities to work for less than minimum wage, federal officials say they plan to undertake a “comprehensive review” of the employment model. The U.S. Department of Labor said it will look at Section 14(c) which is the program that allows employers to pay workers with disabilities less than minimum wage. The Department of Labor wants to hear from people with disabilities and other stakeholders about their experiences and thoughts about the program. 

This effort aligns with the Council’s work on promoting competitive integrated employment.  

Social Security and Supplemental Security Income

Benefits are expected to rise again next year. Monthly benefits will likely increase by 3.2% in 2024. The increase is due to an automatic cost-of-living adjustment, or COLA, that Social Security and SSI beneficiaries receive annually to account for inflation. 

In addition, a bipartisan group of lawmakers in the U.S. Senate and House of Representatives are bringing back legislation that would increase the amount of money that SSI recipients can save without losing their benefits. Currently, individuals cannot have more than $2,000 in assets at any time and the limit for couples is $3,000. The SSI Savings Penalty Elimination Act would increase those caps to $10,000 for individuals and $20,000 for married couples. The legislation would also connect the amounts to inflation going forward.

There was hope that this legislation would pass last year. The sponsors of the bill believe they have additional support from members of both parties and from the House and Senate.  

People with disabilities designated as a group experiencing health disparities

The National Institute on Minority Health and Health Disparities (NIMHD), designated people with disabilities as a population with health disparities for research supported by the National Institutes of Health (NIH). Having this designation is important because it opens up more opportunities for research to understand the difficulties experienced by people with disabilities in accessing health care. Identifying barriers and unmet needs can lead to strategies to address the gaps. This will help improve access and lead to better outcomes.

NIH also issued a notice of funding opportunity calling for research applications focused on novel and innovative approaches and interventions that address the intersecting impact of disability, race and ethnicity, and socioeconomic status on healthcare access and health outcomes. These are important steps at the federal level to address equity in access to healthcare.