STATE UPDATE

Legislative

Much of our attention during the legislative session was focused on the budget which included, among other items, 1,000 Innovations waiver slots and funding to increase wages for direct support professionals (DSP). 

The state is working with the LME/MCOs to distribute the 1,000 Innovations slots.  We expect that 400 will be given out in March, and the remaining 600 to be given out in July. While this is a small step in addressing the over 15,000 people waiting for services, it is a start.  

The state is also working with service providers to distribute the money that was given to increase salaries for DSPs.To receive funds for DSPs they employ, providers must be Medicaid- and/or NC Health Choice-enrolled and recognized by NC Medicaid as a Home and Community Based Service provider. All funds for the wage increase will be given through rate increases to providers who provide HCBS services. All providers who are eligible to participate in the HCBS wage increase are strongly encouraged to distribute no less than 80% of funds received to increase wages of direct care workers identified. There is some concern about the recent changes to the language of 80% being strongly encouraged rather than mandated. The effective date of new rates for workers is expected to be March 1, 2022, instead of Feb. 1, 2022.

We are grateful that this budget begins to address the gaps in the system and the needs of people with developmental disabilities.  We need to continue to educate policy makers about the waiting list and the direct support professional crisis. 

Medicaid Expansion

While the budget does not include expansion, it does create the Joint Legislative Committee on Access to Healthcare and Medicaid Expansion Non Standing Committee - North Carolina General Assembly (ncleg.gov). The committee is made up of nine members appointed by Speaker of the House Tim Moore (R-Cleveland) and nine members appointed by Senate President Pro Tempore Phil Berger (R-Rockingham).

The nine House members appointed to the committee are Rep. Kristin Baker (R-Cabarrus), Rep. Wayne Sasser (R-Stanly), Rep. Donna McDowell White (R-Johnston), Rep. Keith Kidwell (R-Beaufort), Rep. William Richardson (D-Cumberland), Rep. Brian Farkas (D-Pitt) and Rep. Charles Graham (D-Robeson). Rep. Donny Lambeth (R-Forsyth) was appointed co-chair and Rep. Larry Potts (R-Davidson) was appointed vice chair.

On the Senate side, the nine members appointed to the committee are Sen. Ralph Hise (R-Mitchell), Sen. Danny Britt (R-Robeson), Sen. Lisa Stone Barnes (R-Nash), Sen. Kevin Corbin (R-Macon), Sen. Michael Lee (R-New Hanover), Sen. Dan Blue (D-Wake), Sen. Kirk deViere (D-Cumberland) and Sen. Mike Woodard (D-Durham). Sen. Joyce Krawiec (R-Forsyth) was appointed co-chair.

The committee will study various ways to improve access to healthcare and health insurance for North Carolinians, including, but not limited to, Medicaid expansion. The committee will meet this year during the interim and will be allowed to propose legislation. This committee has meetings scheduled on February 18, March 1, and March 15.

The Joint Legislative Oversight Committee on Health and Human Services is also meeting and their next scheduled meeting is on Feb 15.

1915(i)  Home and Community Based Services

North Carolina is currently developing new service definitions under 1915(i) Medicaid waiver. These services would create more options for people with developmental disabilities who are Medicaid eligible. The state’s goal for these services is that they will 1) take the place of the current B(3) services and 2) improve the service array for people with developmental disabilities. Key information about 1915(i) services:

•       ‘i’ services are an entitlement for people who are eligible. So if someone meets the eligibility they cannot be turned away or put on a waitlist. 
•       ‘i’ services will have limits on types of services and limits on hours. 
•       A person has to be Medicaid eligible due to income or SSI eligibility to receive (i) services
•       Individual does not have to meet institutional level of care (as with the Innovations Waiver)

The services that will be included under the (i) waiver include:

•       Community Transition – services to help someone transition from institutional care to community living
•       Respite – can be at home or in a facility; can be planned or unplanned
•       Community Living and Supports – services to help someone live in their own home, family home, or home with other natural supports; similar to Innovations and state funded service
•       Supported Employment – services to support competitive, integrated employment; matches Innovations and state funded definitions 

The 1915(i) option will increase opportunities for home and community based services. 

Increasing Employment for People with I/DD

On Jan 20th the North Carolina Department of Health and Human Services announced the launch of the program Promoting and Expanding Competitive Integrated Employment for Individuals with Intellectual and Developmental Disabilities Strategic Plan. This plan is being launched as part of a formal agreement with the Disability Rights of NC and Center for Public Representation.

The plan will help individuals with intellectual and other developmental disabilities to gain access to competitive integrated employment, which means jobs in the community with a salary above minimum wage and with access to the same benefits as their co-workers. The agreement promises to help over 1,000 disabled NC workers who currently work in segregated settings, often referred to as sheltered workshops or Adult Developmental Vocational Programs (ADVP). In these settings, workers with disabilities are paid below minimum age and often separated from non-disabled workers. This new plan will give people with disabilities support to leave the sheltered workshop and find jobs in the community.

No one will lose their current services. People will receive additional supports and services over the next five years to obtain jobs in the community that pay at least minimum wage.

By July 1, 2022, no new people will enter into ADVPs, and the plan is to end funding for ADVPs by June 30, 2026. 

There is much work to be done over the next several years to make employment, and other integrated community opportunities, available to people with intellectual and developmental disabilities. We celebrate and will continue to track this new state plan as it aligns with NCCDD’s five year plan. 

You can read more about this agreement at the DHHS website. You can also read about it at the Disability Rights North Carolina website. Disability Rights North Carolina and the Center for Public Representation are the two disability advocacy organizations that entered the agreement with DHHS.

FEDERAL

 Build Back Better Agenda, the federal bill that we have covered over the past several months came to a standstill. This bill had the potential to positively affect the lives of people with disabilities and their families. 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

While the original large bill could not get passed in the Senate, Democrats are working on a smaller version of the bill. Since the disagreements that kept the bill from passing were not about the disability items, there is still some hope that a smaller bill that would include education and healthcare items can be passed.  Continuing to educate representatives about how important home and community based services are for people with disabilities is critical.  

Budget

The federal budget has not yet been passed. Congressional leaders released a short-term spending plan on Feb 7 .  The House and Senate are expected to pass the continuing resolution before the next deadline of Feb 18. This will move the next shutdown deadline to March 11. This allows the federal government to continue to operate even though there is no budget in place.

Bill Introduced to End Waiting Periods Which Deny People with Disabilities Access to Healthcare 

On February 3, U.S. Representative Lloyd Doggett (D-TX), Brian Fitzpatrick (R-PA) and Senator Bob Casey (D-PA) introduced the Stop the Wait Act to end harmful waiting periods during which people with disabilities must wait five months to receive Social Security Disability Insurance cash benefits and an additional two years to receive Medicare benefits. This wait places people with disabilities at serious risk of not being able to access health care and facing financial instability. This legislation would ensure that people with disabilities can immediately access the benefits they earned without an unnecessary additional wait. The Arc supports this legislation.

Other Federal News

U.S. Secretary of Education Miguel Cardona is pushing for more funding to meet the needs of students with disabilities and to support special education teachers. In a major speech late last week, Cardona said that it’s not enough for students to be back in school after classrooms across the country went virtual in response to the COVID-19 pandemic. The nation needs to do more to ensure that children, including those with disabilities, are successful, he said.

Cardona specifically highlighted special education as an area that needs attention.“It means increasing funding for the Individuals with Disabilities Education Act so that every eligible child with a disability can access a free, appropriate public education,” Cardona said. “It means not allowing for a culture of low standards or low expectations for some students and families over others.”

The education secretary also indicated that he wants to see “funding and pushing for additional special education teachers, and investing in educators and paraprofessionals — in their well-being, and in recruiting and retaining them.”

Democrats in Congress have put forward bills that would significantly increase federal special education spending, but the legislation is currently stalled.