STATE UPDATE

Budget Follow-up

Last month we reported on the final state budget which included more items related to people with intellectual and other developmental disabilities (I/DD) than other budgets in recent history. Funding of an additional 1,000 Innovations Waiver slots and recurring funding to increase direct support professionals (DSP) wages are two of the highlights that directly relate to the priorities of the NCCDD. The Division of Health Benefits (DHB) is working to distribute the Innovations slots to the Local Management Entities/Managed Care Organizations (LME/MCOs). The legislation called for 400 slots to be implemented in March and the remaining 600 slots to be implemented in July. The state is also gathering information from providers to determine the number of DSPs across the state who are eligible for the wage increase.

The budget that was passed also included requirements for the Department of Health and Human Services to provide reports to the legislature. One of these reports is due on March 1:

Plan For Adequate Provider Supply for Services Provided Through the Innovations Waiver

Requires NC DHHS to plan for additional Innovations Waiver slots that could be added in the future. “No later than March 1, 2022, DHB shall submit a report to the Joint Legislative Oversight Committee on Medicaid and NC Health Choice that outlines the plans for adding a minimum of 1,000 waiver slots in the 2023-2025 fiscal biennium and that contains recommendations for ensuring that there would be adequate health care providers to support the needs of the additional individuals served under the waiver should the number of slots be increased in the future.”

The request for this report indicates that the intent of the legislature is to fund additional Innovations slots in the future; but they also want to ensure that there will be providers and DSPs to provide the waiver services and supports.

Managed Care Transformation Update

Tailored Plan implementation, which was scheduled for July 2022, has been delayed until December 2022.  The delay in the state budget, along with the on-going work on Care Management and the 1915(i) benefit, played into the decision for the needed delay. Both Care management and 1915(i) supports need to be ready at the same time as the Tailored Care launch. The NCCDD is actively involved in providing input into the development of these important aspects of the system. It is a priority that family navigation and peer support be included in these definitions. There is representation on the Tailored Care Management Technical Assistance Group (TAG), as well as participation with the Developmental Disabilities Consortium to develop a position paper on this priority.

Olmstead Plan

The Department of Health and Human Services (DHHS) released the first draft of the Olmstead Plan in the fall and received a great deal of feedback from the community. The updated plan was made public on January 12. The expectation was that the plan will address four main areas: 1) competitive/integrated employment, 2) direct support professionals, 3) Psychiatric Residential Therapeutic Facilities (PRTFs), 4) transition to community.  The revised plan will be reviewed for more requirements for data, as well as meaningful measures of success in addressing the institutional bias in our service system. The NCCDD will provide an update and summary of the revised plan.

FEDERAL

Budget

Build Back Better Agenda, the federal bill that could greatly affect the lives of people with disabilities and their families, has come to a standstill after agreement on some of the items could not be reached. This bill contained funding for Home and Community-Based Services including:

• $150 billion over 10 years for home and community-based services (HCBS) to eliminate waiting lists for services and bolster pay for direct care workers.
• Making the Money Follows the Person program permanent to help people with disabilities who want to leave congregate care and transition to live in their own home and community with supportive services.

It is disappointing that this legislation, which has the potential to increase community opportunities for people with disabilities and address waiting lists, has stalled.  However, it is important to note that the disagreements about the bill were not about the disability-related items. Education and advocacy continue in the hope that some of the disability-related funding could be included in the 2022 spending bill or passed through some other means.

House and Senate Appropriations panels failed to reach agreement on the dozen annual spending bills that fund federal agencies for the 2022 fiscal year. Congress passed one continuing resolution in September to extend the time to work on the budget until Dec 3. Then on Dec 2^, Congress approved a short-term spending bill that will keep federal agencies running through Feb. 18, 2022. So, work continues on the full 2022 federal budget.

Social Security Benefits

Millions of Americans with disabilities are seeing a big bump in their Supplemental Security Income and other Social Security benefits. Monthly payments are growing 5.9%, according to the Social Security Administration. The change applies to SSI payments beginning Dec. 30 and Social Security benefits paid this month. The increase is due to an annual automatic cost-of-living adjustment, or COLA. This year’s COLA is the largest it’s been since 1982. For individuals receiving SSI, the maximum federal benefit for 2022 will rise to $841 per month. The figure is $1,261 for couples. Actual payments could be higher since some states contribute more.

The Social Security Administration said it mailed notices in December to beneficiaries detailing new payment amounts. Most people can also access the information online through their Social Security account, the agency said.

ABLE Accounts

For the first time in four years, the amount of money that people with disabilities can save without jeopardizing eligibility for government benefits is rising. Starting this month, the Internal Revenue Service said that the federal gift tax exclusion is growing from $15,000 to $16,000 annually. That same cap also applies to contributions to ABLE accounts, a special savings vehicle for people with disabilities.

ABLE accounts, which were created under a 2014 law, allow individuals with disabilities to save up to $100,000 without risking eligibility for Social Security and other government benefits. Medicaid can be retained no matter how much is in the accounts. Interest earned on funds in ABLE accounts is tax-free, and money saved can be used to pay for qualified disability expenses including education, health care, transportation and housing.

Annual deposits in ABLE accounts are generally limited to the value of the IRS’ gift tax exclusion, now $16,000. However, people with disabilities who are employed can also save some of their earnings in the accounts above and beyond the gift tax amount. For those in the continental U.S., that means up to an additional $12,880 this year, according to the ABLE National Resource Center.