Public Policy Update (as of 5/24/24)

Federal Updates

Budget

The President’s proposed budget request for 2025 fiscal year, which begins in October, included $150 billion over 10 years “to strengthen and expand Medicaid home and community-based services.” Beyond requesting more investment in home and community-based services, Biden’s budget includes a $200 million increase in spending on special education services, $10 million more to train special educators and early intervention providers as well as funding to improve customer service at the Social Security Administration. This budget request highlights the president’s priorities but is only the first step in the federal budget process. It is now up to Congress to determine what will ultimately be included in the federal budget for the upcoming year.

Congress has begun work on the Fiscal Year (FY) 2025 budget. The House is holding hearings and writing appropriations bills. On May 16, Chairman Cole (R-OK) released the schedule for the mark-up of the twelve appropriations bills, including the Labor-Health-Human Services-Education and Related Agencies (LHHS) bill. The LHHS bill is scheduled for mark-up on Thursday June 27 in the LHHS Subcommittee and to be marked-up in the Appropriations Committee on July 10. Chairman Cole also released the Interim Fiscal Year 2025 Subcommittee Allocations. These allocations are the amount of funding that each appropriations bill will have to allocate to programs in its jurisdiction in FY 2025. The Senate is also working to hold hearings and write bills.

Recognizing the Role of Direct Support Professional Act (S 1332)

This bill was Introduced by Senator Collins (R-ME) and Senator Hassan (D-NH) in April 2023 and passed by the Senate in March 2024. It will help address the need for more Direct Support Professionals (DSPs) in the workforce by ensuring that the government collects more data on the people who help people with disabilities every day. This bill has been sent to the House, where there was a similar bill introduced for consideration last April.

A Stronger Workforce for America Act (HR 6655)

The Workforce Innovation and Opportunity Act (WIOA) was signed into law on July 22, 2014. WIOA is designed to help job seekers access employment, education, training, and support services to succeed in the labor market and to match employers with the skilled workers they need to compete in the global economy. This bill would make critical improvements to WIOA. It would strengthen the relationship between employers and the workforce system, support workers to improve their skills, ensure greater efficiency and accountability to WIOA programs, and strengthen pathways to economic opportunity and support innovation for a skills-based economy.

Alternatives to Guardianship Education Act

On May 8, Senator Casey (D-PA) and Representative Gay Scanlon (D-PA-5) introduced the Alternatives to Guardianship Education Act (S 4283 / HR 8328). The bills will help increase awareness of alternatives to guardianship, like supported-decision making and sharing information and resources with health care workers, educators, family members, and court personnel through education programs. The bills also require states to collect data on guardianships and will create grant programs to implement education programs to increase awareness of guardianship alternatives and more. The bill was referred to the House Education and Workforce Committee and the Senate Health, Education, Labor and Pensions Committee.

Ensuring Access to Medicaid Services (Access Rule)

The U.S. Department of Health and Human Services issued a final rule on April 22 to help improve access to home and community-based services (HCBS) as well as improve the quality of jobs for caregivers. The rule will require:

• At least 80 percent of Medicaid payments go to caregiver wages.
• Transparency by states in how much they pay for services and how rates are set.
• Creation of an advisory group made up of people receiving services, providers and other stakeholders to provide input on rates and compensation for direct care workers.

There is a several year implementation process and states will be working to understand and implement requirements over the next several months.

Proposed Rule to Ban Electrical Stimulation Devices

The U.S. Food and Drug Administration (FDA) announced a proposed regulation that would ban the use of electrical stimulation devices that are used to treat self-injurious or aggressive behaviors. The FDA tried to ban these devices in 2020 but their decision was challenged in court where the court determined that the FDA did not have the authority to ban them. Since that decision, changes to the Federal Food, Drug, and Cosmetic Act made it clear that the FDA does have authority to issue this ban. The proposed rule will be up for public comment until May 28, 2024 at which point the FDA will review and decide whether to proceed with finalizing the regulation. The proposed rule is available online at www.regulations.gov.

State

The legislative short session began on April 24, 2024. The short session is designed primarily for review and adjustments to the two-year budget that was approved last session. The Governor released his budget which included the following priorities:

• Ensuring a strong Medicaid program
  • Funds for rebase to address costs, rates, services
  • Physician/provider rates to 90% of medicare rates
  • Expansion of Healthy Opportunities Program
• Addressing Early Education and Child Care Crisis
  • Statewide rate floor for child care subsidy
  • Increased rates for NC PreK
• Supporting Aging Populations and North Carolinians with Disabilities
  • $180 million to support DSPs
  • 1,000 Innovations slots
  • Increase guardianship rates
• Supporting essential services by addressing workforce needs
  • 5% increase state employees
  • Additional positions within DHHS

The Governor’s budget was the start of the process. The legislature is now in the midst of their budget process. The state has about a $1 million revenue surplus this year, which is less than what was projected in the spring, but still a substantial amount. The Senate and House are both working on proposed budgets but have not reached an agreement.

I/DD Omnibus Bill (HB 1003)

This bill includes funding for DSP wages, Innovation Waiver slots, other services like housing and employment supports, as well as banning the use of prone restraints and requiring schools to notify parents when seclusion and restraint is used on a child. This bill highlights some of the priorities of the I/DD community. Advocates hope at least part of this bill will be rolled into the budget.

Unmasking Mobs and Criminals Bill

The Senate passed this bill which includes language around penalties for wearing a mask during demonstrations or committing a crime. It also includes the repeal of the physical health and safety exemption to laws prohibiting wearing masks on public property. This section of the bill is potentially detrimental to people with disabilities and others who may experience health issues. There has been considerable feedback from advocates. The House did not concur with the Senate version of the bill, so the bill is now in conference committee.

Tailored Plans

The Department of Health and Human Services (DHHS) is moving forward with implementation of Tailored Plans on July 1, 2024. Letters were mailed in mid-April to anyone moving to a Tailored Plan. If a person did not choose a primary care provider (PCP) by May 15, the Tailored Plan assigned one to the person. People can change their PCP through January 31, 2025. Member ID cards and welcome packets should be sent at the end of May. The North Carolina Council on Developmental Disabilities will continue to monitor how the roll-out proceeds and the impact on access to providers. If you think you have been incorrectly enrolled, have the wrong primary care provider assignment, or are having other problems with Medicaid, you can contact the Medicaid Ombudsman at 1-877-201-3750 and/or contact your Local Management Entity (LME) for assistance.