STATE

Legislature

The short session is scheduled to begin April 24, 2024. The short session is designed primarily for review and adjustments to the two-year budget that was approved last session. With the elections coming up, the expectation is that this session will be quick. One critical area of focus for individuals with intellectual or other developmental disabilities (I/DD) advocates is to increase the funding allocated last session for direct support professional wage increases. As a reminder, $60 million was included in the budget which fell short of the $90 million needed to achieve the targeted increases. Continuing education and advocacy around the waitlist is also a critical topic.

While the session has not yet started, the Legislative Oversight Committees (LOC) are meeting. Both LOC on Health and Humans Services and the LOC on Medicaid met in February and plan to meet again in March.

Appendix K Flexibilities

During the Public Health Emergency of the COVID pandemic, the federal government allowed states to create flexibilities in their waiver services (Innovations, Traumatic Brain Injury (TBI) waiver). After the Public Health Emergency, NC asked the federal government for permission to continue many of the flexibilities. Below are some of the areas that will continue:

• Telehealth for Community Living Support.
• Increase the Innovations waiver cap from $135,000 to $184,000.
• Allow parents of minor children receiving Community Living Support to provide this service to their child who has been indicated as having extraordinary support needs up to 40 hours/week.
• Allow Supported Living to be provided by relatives.
• Allow relatives as providers for adult waiver members to provide above 56 hours/week, not exceeding 84 hours/week of Community Living Support.

For a complete list of flexibilities: https://medicaid.ncdhhs.gov/blog/2024/01/30/nc-medicaid-guidance-sunsetting-innovations-waiver-appendix-k-flexibilities

Direct Care Workforce Reports

Recently, two reports related to the direct care workforce were released (one in late 2023 and the other in January 2024) that shared recommendations to improve NC's Direct Care Workforce, also referred to as Direct Support Professionals.

The NC Area Health Education Centers Program (AHEC) report focused on developing a plan for certification of direct care workers in order to increase recruitment and retention of the Home- and Community-Based Services (HCBS) Direct Care Workers (DCWs). The recommendations from this report included: 

• An umbrella system for credentialing DCWs that incorporates new and existing training options.
• Adopt common core competencies for all direct care workers.
• Ensure training is accessible for all workers, including paid training time
• Develop infrastructure for the administration and oversight of credentialing.
• Connect competency attainment with wage and rate differentials. (Make sure DCWs are paid for these added skills/trainings and that they are paid to get trained).
• Provide additional wraparound support services to direct care workers. 

Link to the full report: https://www.ncdhhs.gov/nc-ahec-recommendations-dcw-hcbs-worker-certification/download?attachment

Caregiving Workforce Strategic Leadership Council is a workforce group organized by NC Department of Health and Human Services and the NC Department of Commerce. The goal of their work and report was to use data and expert input to identify strengths and challenges facing this critical workforce and to develop coordinated action. This report outlines actions steps in the following areas: 

• Define what the direct care workforce is.
• Collect more comprehensive and better data for the direct care workforce.
• Create a living wage for direct care workers.
• Expand apprenticeship programs.

Here is the link to the full report: https://www.ncdhhs.gov/investing-north-carolinas-caregiving-workforce-recommendations-strengthen-north-carolinas-nursing/download?attachment

FEDERAL

Budget

On January 7, a bi-partisan topline agreement on funding levels for Fiscal Year 2024 was reached. At that time, there was a Continuing Resolution (CR) in place that was set to expire on January 19. (As a reminder, a CR continues last year’s funding levels while Congress works to complete a budget for the federal government for Fiscal Year 2024). With no agreement on a budget, on January 18 the House and Senate both passed a third CR to avoid a partial government shutdown on January 19. The President signed the CR on January 19. The new CR measure extends the "laddered” approach with deadlines of March 1 for Agriculture, Military Construction/VA, Energy/Water, and Transportation/Housing and Urban Development bills and March 8 for Labor, Health and Human Services, Education (LHHS), Defense, State/Foreign Operations, Commerce/Justice/Science, Financial Services, Interior/Environment, Legislative Branch, and Homeland Security bills.

House Passes Bill to Ban Use of Quality-Adjusted Life Years (QALYs)

On February 7, the House of Representatives passed the Health Care for All Patients Act (H.R. 485) to prohibit the use of quality-adjusted life years (QALYs) and other similar metrics in all federal programs. The use of QALYs in health care decision-making is inherently discriminatory—a year of life with a disability is counted as lower quality and of lower value than life without a disability. This could result in people with disabilities being denied access to health care. This bill would ban using QALYs. The bill passed the House and will move to the Senate.

Senate Committee Passes FAA Reauthorization

On February 8, the Senate passed a five-year reauthorization of the Federal Aviation Administration (FAA). The bill includes several positive provisions for people with disabilities, including:

• A pilot grant program for improving accessibility at airports.
• Improved training requirements for employees assisting passengers with wheelchairs.
• Improved training requirements for employees responsible for the storing of wheelchairs and scooters.
• A requirement that airlines improve the accessibility of their websites.
• A requirement that airlines share the dimensions of cargo holds and entries for all aircraft types and refund passengers if their wheelchair cannot be transported.

Eliminating Marriage Penalty in SSI Act (HR 7055)

This bill was introduced in the House with bi-partisan support. It would exclude a spouse's income when determining eligibility for Supplemental Security Income (SSI). It would also disregard marital status when calculating the SSI benefit amount for an adult with I/DD.

U.S. Department of Education Releases Assistive Technology (AT) Guidance

The Department of Education released guidance to improve access to assistive technology (AT) in schools. The guidance links the use of AT to the Individuals with Disabilities Education Act (IDEA) and clarifies the uses of AT in the educational setting. It also identifies possible funding sources. The purpose of the guidance is to increase access and the use of AT.

Read the guidance from the U.S. Department of Education

FDA to Ban Shock Devices

In the on-going effort to ban the use of shock devices, the FDA has indicated that it plans to issue a ban. The FDA banned the use of shock devices in 2020, but this was overturned when the courts ruled that the FDA did not have the authority to ban these devices. Last year, Congress passed legislation giving the FDA the authority. Since that time, disability advocacy groups including the Autistic Self Advocacy Network, the Autism Society of America, The Arc US, and the National Disability Rights Network have called on the agency to move forward on a ban without delay. There is hope that this will happen very soon.