FEDERAL

Appropriations

In late July and early August, the House and Senate passed the Bipartisan Budget Act of 2019.  The agreement increased discretionary spending for fiscal years 2020 and 2021 and lifted the debt ceiling through July 31, 2021. As the House revises its appropriations and the Senate begins its process, a continuing resolution may be needed in the interim to maintain government funding.

Voting

NC Districts 3 and 9 will hold special elections on September 10 to fill vacant seats in the US House of Representatives.  Early voting will be held August 21 through September 6. Voting resources can be found at Disability Rights NC’s dedicated voting website: Access The Vote North Carolina

Money Follows the Person

After a series of short-term funding measures, the widely popular state grant program received $122.5 million of funding through 2024 with the passage of Sustaining Excellence in Medicaid Act of 2019. The bipartisan bill also funds the Family2Family Health Information Centers found in each state.

STATE

Legislature  

There has been very little movement in the budget process since the last issue of Highlights & Hot Topics. The state is currently operating under last year’s budget. As a reminder, the approved legislative budget was sent to the Governor, who vetoed the budget bill because Medicaid expansion was not included. The House has a veto override on their agenda but does not appear to have enough votes to override the veto. So, we continue to wait. As described last month, the following items were included in the budget that was approved by the legislature, and we hope that these will remain through the negotiations regarding Medicaid expansion.

• Medicaid Transformation Funds: Dollars to support the transition to Medicaid managed care. Most of this is to pay for the fee-for-services claims that will continue through the transition.   
• Expanding Innovations Waiver: The budget includes 500 slots to begin in January 2020 and 500 slots to begin in January 2021.   
• Traumatic Brain Injury Funding: The budget includes recurring dollars in each fiscal year of the biennium for TBI services.
• Supplemental Short-Term Assistance for Group Homes:  This funding fills a gap created when some people with I/DD lost funding due to eligibility changes to Personal Care Services.
• ICF Group Home Wages: The budget increases the capitation rates for LME/MCOs to enable increases in the wages paid to direct support personnel working in ICF group homes for individuals with I/DD to align with wages paid in the Developmental Centers
• Innovations Wages: Funds are included to conduct and actuarial analysis and wage and hour study of Innovations program to determine what is needed to increase wages to align with wages in Developmental Centers.
• Addressing Unmet Needs in Innovations Waiver: Budget calls for a ten-year plan to be developed by the Division of Health Benefits (DHB) with input from stakeholders to address the waiting list.
• Evidence-Based Supported Employment: Provides funds to APSE to develop training to implement supported employment.

Medicaid Transformation continues to move forward with Standard Plan expected to launch in November. DHHS is continuing to proceed with steps necessary to launch, but if there is not a resolution on the state budget, implementation will likely be delayed as there are needed funds for the transition to managed care included in the budget.

• The Medicaid Managed Care call center (833-870-5500) and website went live on June 28. Beneficiaries are already using both to learn more about managed care and enroll in a health plan.
• In July, letters were sent out to Medicaid beneficiaries in Regions 2 and 4 explaining the new way of receiving health benefits through Medicaid.
• Individuals with intellectual or other developmental disabilities (I/DD) who are in the NC Innovations Waiver will NOT receive a letter. They will remain in the current fee for service Medicaid called Medicaid Direct for medical services and continue to receive Innovation Services through the LME/MCO until 2021.
• People who have Medicaid as their health insurer and are using Medicaid b3, state funded (IPRS), or other Medicaid services (e.g. ABA through Medicaid, Research-Based Behavioral Health Treatment) and are NOT on the Innovations waiver, will get a letter indicating options to enroll in a Standard Plan or remain in the Tailored Plan. It is important to know if someone moves to the Standard Plan, they will no longer be able to receive state-funded services and supports.
• The Behavioral Health/IDD Tailored Plan is being developed with a projected launch in July 2021. The design of the program is now available for review. On August 2, the Department issued several updates to the March 2019 eligibility and enrollment policy guidance for Behavioral Health I/DD Tailored. The updates included:
  • New forms for beneficiaries assigned to Standard Plans to request to stay in NC Medicaid Direct (fee for service) and the LME-MCO.
  • Updated enrollment policy to transition Standard Plan enrollees who urgently need a service covered only by NC Medicaid Direct/LME-MCO. A new policy allows for urgent transfer requests.
  • Additional criteria for I/DD were included. More genetic syndromes were included, and use of enhanced crisis services during 18 month look-back period was added as criteria for the Tailored Plan.