Public Policy Update (as of 4/24/25)

Federal

Congressional Budget Process

On April 5, 2025, the Senate passed their budget resolution which includes a reduction of $880 billion to Energy and Commerce which is where the Medicaid budget is housed. Senators Josh Hawley (R-MO) and Ron Wyden (D-OR) cosponsored an amendment to remove language in the budget resolution which would direct the House Energy and Commerce Committee to cut $880 billion. That amendment was defeated 50-49.

On April 10, 2025, the House of Representatives passed this updated budget resolution.

The reconciliation process has now begun, and committees have been instructed to write legislation that will extend President Trump’s 2017 tax cuts, increase funding in some areas (border security, increase defense spending), and make reductions to Medicaid and other programs in Energy and Commerce.

Medicaid comprises $8.2 trillion out of the $8.6 trillion in mandatory spending that Energy and Commerce must use to come up with spending reductions (assuming Medicare cuts are off the table). As a result, major cuts to Medicaid appear to be the only way to meet the budget resolution requiring $880 billion spending reductions.

There are a variety of options available for cutting Medicaid including per capita caps, lowering the match rates for states, and reducing Affordable Care Act match rates - all of these would leave the states facing difficult choices to raise revenues or cut spending. Cuts to Medicaid spending could mean dropping coverage for some people, eliminating coverage of high-cost optional benefits, or cutting payment rates to health plans and providers.

Protect Our Care has an easy tool to find your elected official and some advice on what to say - https://www.protectourcare.org/hands-off-medicaid. Call your Member of Congress and educate them on the importance of Medicaid for people with disabilities and their families and caregivers.

President’s Budget

On April 16, 2025, a draft of the President’s budget was leaked, and it included proposed budget cuts of $40 billion from the US Department of Health and Human Services. Many disability-related programs were identified for elimination including Developmental Disability Councils, Developmental Disability Protection & Advocacy, Projects of National Significance, the National Institute on Disability, Independent Living, and Rehabilitation Research and University Centers for Excellence in Developmental Disabilities.

While the President’s budget is required to be submitted each year, it is not law. Congress receives it but is not required to implement it. However, it does indicate the policy and funding priorities of the administration. This budget indicates a desire to dramatically cut disability programs.

Protect Our Care has an easy tool to find your elected official and some advice on what to say - https://www.protectourcare.org/hands-off-medicaid. Call your Member of Congress and educate them on the importance of Medicaid for people with disabilities and their families and caregivers, and the importance of disability programs in the Department of Health and Human Services.

Department of Health and Human Services (DHHS) Restructuring

The federal DHHS is being reorganized and is moving from 28 divisions down to 15. The workforce is being downsized by 20,000 employees. As part of these reductions, the Administration of Community Living (ACL) was eliminated. Programs that were part of the ACL, including DD Councils and Protection and Advocacy agencies, have been moved to other divisions. While for the immediate future, it appears that the funding will be maintained for these programs, the loss of expertise in these divisions and the threat of cuts threatens the future of the vital services provided by these agencies.

State

Budget

Legislative Budget

The Senate passed its proposed budget on April 17, 2025. The budget did not include rate increases for DSPs or Innovations waiver slots. Also missing were increases for exceptional children funding or additional funds for Employment and Independence for People with Disabilities (EIPD) which would have allowed North Carolina to pull down federal funds.

The only funding related to people with I/DD in the budget was directed to Community Colleges to expand I/DD programs from 15 to 25 statewide.

The budget now has been sent to the House where they will develop their proposed budget. Any differences will be worked on in a conference committee.

Bills of Interest

• Sam’s Law (HB 4) – Requires action plans for students with certain medical conditions.
  Driver’s License Designation/Autism (HB 21) – DMV would be required to develop a designation of autism on licenses, upon request. This bill also includes training for officers.
• Create Alert/Missing Person with Disability (H8 57) – Requires creation of an alert for missing persons with disabilities within the NC Center for Missing Persons. The Center would work with law enforcement to develop guidelines for missing persons with disabilities.
• The DAVE Act (S 474) – This bill would require the office of the State Auditor to establish a Division of Accountability, Value, and Efficiency (DAVE).
  • Every executive branch/State agency would be required to report to DAVE annually to justify each agency’s continuing existence and the continuing need for any vacant positions.
  • The bill would also authorize the use of AI for DAVE to examine agency records and budgets for amounts spent, duplicative spending, and the effectiveness of expenditures regarding their intended purpose.
  • DAVE would then report to the NCGA annually and have the authority to recommend dissolving agencies and eliminating positions within agencies.