FEDERAL (Accurate as of 01/15/2020)

Budget & Appropriations

All 12 Fiscal 2020 spending bills – a $1.3 trillion spending package – were passed by the House and Senate and signed by President Trump on December 20. Looking through the lens of disability-related programs, the majority of the spending package remained at or just above level funding with a few notable exceptions. A comprehensive comparison chart created by The Arc of the U.S. can be found here.

This measure also included a number of tax cuts (approximately $426 billion over 10 years) including two Affordable Care Act (ACA) taxes.

Money Follows the Person

In late December, Congress approved and President Trump signed a five-month extension of the Money Follows the Person (MFP) program as part of the Further Consolidated Appropriations Act, 2020 (H.R.1865). Congress has yet to approve a permanent reauthorization despite significant bipartisan support in the House and Senate.

Health

Litigation over the Affordable Care Act continues.  On December 18 in a 2-1 decision, the Fifth U.S. Circuit Court of Appeals declared the individual mandate of the Affordable Care Act (ACA) unconstitutional after Congress reduced the penalty to $0 and sent the case back to the lower court to determine which parts of the law will remain in effect. The Supreme Court, responding to an expedited request by proponents of the ACA, is weighing when it may hear the case. Many of the law's most popular provisions could be in jeopardy, including protections for people with pre-existing conditions, allowing parents to cover their children until age 26, eliminating annual and lifetime limits on coverage, and other provisions critical to many individuals with disabilities.

Family Medical Leave

On December 17, Democrats in the House and Senate introduced the Family Medical Leave Modernization Act (S.3071/H.R.5456). This bill expands the current Family and Medical Leave Act definition of family to include domestic partners, parents-in-law, aunts, uncles, siblings, adult children, grandparents, grandchildren, sons- or daughters-in-law, and other significant relationships. Furthermore, it guarantees that parents and other family caregivers can take time off to attend medical appointments or school functions, including parent-teacher conferences, without a risk of losing their job.

Two days later,  President Trump signed the National Defense Authorization Act of 2020 (S.1790), which includes a provision providing federal employees 12 weeks of paid parental leave caring for newborns, newly adopted children or foster children. Under this bill, paid leave would not extend for personal medical issues or to care for a family member. 

Federal policy opportunities:

The annual Disability Policy Seminar will be held in Washington, D.C. March 23-25, 2020 at the Renaissance Hotel. Click here to register or for more information.

Elected for Inclusion: A Presidential Forum on Disability has been postponed due to the timing of the January Democratic presidential debate and other factors. For more information, see the statement from organizers, the American Association of People with Disabilities and REV UP Texas.

STATE (Accurate as of 01/15/2020)

Legislative

The General Assembly convened on Tuesday, January 13 for one day and did not vote on the budget.  At this point, the Senate does not have the votes to overturn the Governor’s budget veto. It is unlikely that the budget will be taken up when the legislature returns for the short session. We will most likely be waiting until after the November elections for movement on budget.  The key areas of contention remain the same – Medicaid expansion, education funding, and tax cuts for businesses. As discussed previously, the budget contained funds necessary for the Medicaid transformation that had been planned to start in February. 

Medicaid Transformation Update

Suspension of Medicaid Managed Care is still in effect. The decision to lift the suspension is dependent on legislative actions. Despite the suspension, the Department of Health and Human Services continues its work on policy related to the transformation. There are opportunities for public comment on this work. 

On Dec. 30, 2019, The Department of Health and Human Services issued the following policy paper for public comment:

North Carolina’s Design for State-funded Services Under Behavioral Health and Intellectual/Developmental Disability Tailored Plans: This paper describes the Tailored Plan which is designed to serve individuals with behavioral health and intellectual disabilities. In addition to managing Medicaid services, Behavioral Health I/DD Tailored Plans also will be responsible for managing State-funded behavioral health, intellectual/developmental disability (I/DD), and traumatic brain injury (TBI) services as the Local Management Entities-Managed Care Organizations (LME-MCOs) do today for the uninsured, underinsured and Medicaid beneficiaries. The Department welcomes feedback at [email protected] by Jan. 29, 2020.

On Jan. 8, 2020, the Department of Health and Human Services issued two policy papers for public comments detailing the strategy to promote value-based care in NC Medicaid Managed Care. While these focus on the Standard Plan, it is important to also pay attention to these since there will be some individuals with IDD who will be in the Standard Plan.

North Carolina’s Value-Based Payment Strategy (VBP) for Standard Plans and Providers in Medicaid Managed Care. This paper describes the vision for value-based payments between Prepaid Health Plans and providers in NC Medicaid Managed Care.

North Carolina’s Medicaid Accountable Care Organizations (ACOs) for Standard Plans and Providers: Building on the Advanced Medical Home Program to Drive Value-Based Payment. This paper provides details on an optional Medicaid ACO program, including ACO organizational requirements, payment parameters, total cost of care calculation and participation incentives for early adopters. PHPs and providers can form ACO arrangements to promote value in Medicaid and meet the Department’s VBP targets.

The Department welcomes feedback on both papers at [email protected] by Feb. 19, 2020.