Read a summary of recent public policy updates that may be of interest to North Carolinians with intellectual and other developmental disabilities (I/DD). These updates are current as of May 22, 2025.

STATE

Budget

The House released its budget on May 22, 2025. This follows the release of the Governor’s budget and the Senate budget. Below is a comparison of the budgets in areas related to I/DD.

There are additional items of difference between the two budgets including taxes, state employee raises, teachers’ salaries, and additional funding for Hurricane Helene relief.

The Senate is expected to vote not to concur with the House budget, which will set up the conference process between the two chambers. A Conference Committee will convene to work out differences and finalize a budget to send to the Governor.

Bills  

The following are bills that met the crossover deadline and can be considered this session.

H171 Equality in State Agencies/Prohibition on DEI – This bill eliminates Diversity Equity Inclusion initiatives in state and local government agencies. It defines DEI as programs or policies that influence hiring or employment practices based on race, sex, color, ethnicity, nationality, or sexual orientation, except through merit-based processes.

H4 Sam’s Law – This bill requires schools to develop action plans for students with certain medical conditions.

H21 - Driver’s License Designation/Autism – This bill requires Department of Motor Vehicles to develop a designation of autism on licenses, upon request. It also includes requirements for training for law enforcement officers.

H562 - Community College Behavioral Health Workforce Act - The bill directs the Commission for Mental Health, Developmental Disabilities, and Substance Abuse Services to engage in rulemaking to amend staff definitions for certain qualified professionals. The two positions most related to IDD that are required to be amended are:

• Associate Professional may be a graduate of a community college with an associate degree in a human services field with less than two years of experience with the population served.
• Qualified Professional may be a graduate of a community college with an associate degree in a human services field and has two years of supervised mental health, developmental disabilities, and substance abuse services experience with the population served.

S403/H491 – Medicaid Work Requirements - The bill mandates the Department of Health and Human Services, Division of Health Benefits (DHB), to negotiate with the Centers for Medicare and Medicaid Services (CMS) for the implementation of work requirements as a condition for Medicaid participation, should CMS authorize such requirements.

S474 – The DAVE Act - 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.  

FEDERAL 

Large overall cut - According to Congressional Budget Office, the bill would cut Medicaid by at least $716 billion, the largest cut in the program’s history.

• Work Requirements - Millions of people in the Medicaid expansion population would be at risk of losing Medicaid under a provision for work requirements which requires 80 hours of work, volunteering, or school. While there are exemptions for people with disabilities, past experience has shown that even people who are supposed to be protected, and people who are working, often lose coverage due to the ‘red tape’ of documenting and reporting the 80 hours. This puts administrative burdens on individuals, counties, and states.
• Effects on Medicare recipients - One provision would take Medicaid coverage away from people, mostly seniors and those with disabilities who also have Medicare, due to provisions that make it harder to get and stay enrolled in Medicaid.
• More Frequent Eligibility Check - Some people would also lose coverage due to new requirements that expansion enrollees re-prove their eligibility every six months (instead of annually). These requirements frequently end up pushing eligible people off Medicaid because they don’t receive or submit the necessary paperwork, or because the state fails to process the paperwork.
• Reduction in Federal Matching - More than 30 states, including North Carolina, would see large federal funding cuts for their Medicaid expansion if they continued to provide health coverage to people who do not meet the very restrictive “qualified alien” immigration eligibility requirement. Currently some women and children who are here legally, but have not yet obtained US citizenship, are covered in NC. Keeping this would result in a lowered federal match for Medicaid expansion from 90% to 80%.
• Co-Pays - The legislation would also raise costs for Medicaid expansion enrollees and will lead many of them to defer needed care. The bill requires states to charge working people with incomes just above the poverty line — $16,000 year for an individual — new cost-sharing charges when they go to the doctor.

While not all of these cuts and changes in policy have a direct impact on people with I/DD, their impact on state Medicaid programs make difficult for states to maintain optional Medicaid services – which are the services that provide home and community based supports for people with I/DD.

What’s next? The bill heads to the Senate. There are expectations that there will be revisions to the bill in the Senate, specifically around the Medicaid changes. There are Senate members who are concerned about the impact of the Medicaid cuts on their states. So amendments are expected. This will require negotiations between Senate and House before a bill could be sent to the President for signature.

Make you voice heard about the impact of these cuts on people with I/DD!

Join NCCDD for its Monthly Policy Education Meeting 

The North Carolina Council on Developmental Disabilities (NCCDD) holds monthly meetings to discuss current policy issues that impact people with intellectual or other developmental disabilities (I/DD). NCCDD supports policies that encourage the integration between people with intellectual or developmental disabilities (I/DD), those who support them, and the community. NCCDD provides this information to educate and inform. We do not lobby on specific legislation.

Join our Public Policy Education Meetings on the second Thursday of every month via Zoom. The meetings are free and open to the public. No registration required. Join the meeting at this link: https://www.zoomgov.com/meeting/register/vJItdu-uqD8oHpxzFX9FiES_lSmk_8OP4r4#/registration