FEDERAL

Budget and appropriations

While the House has passed the majority of its appropriations (spending) bills for 2020, the Senate is likely to wait until after the August recess. One of the major sticking points: bicameral agreement on spending caps. This will require fast-paced work in September when debt ceiling discussions will also be underway.

Independent Living, Respite and Autism

In mid-June, a Money Follows the Person funding extension passed the House (H.R. 3253) with a bipartisan vote including many members of North Carolina’s delegation. All eyes are on the Senate to pass the EMPOWER Care Act (S. 548). If the Senate passes its bill, states will have steady funding for this critically important and successful program funding the transition of individuals out of institutional care while providing community-based supports.

On July 11, the Health Subcommittee of the House Committee on Energy and Commerce unanimously voted to approve the Autism Collaboration, Accountability, Research, Education, and Support (CARES) Act of 2019 (H.R.1058); and the Lifespan Respite Care Reauthorization Act of 2019 (H.R.2035). The next hurdle: approval by the full House Energy and Commerce Committee. 

Tax policy

On June 18, the Economic Mobility Act of 2019 (H.R.3300) was introduced in the House. This bill makes improvements to the earned income tax credit, child tax credit and dependent care assistance, most of which last for two years. Additionally, it repeals a provision of the Tax Cuts and Jobs Act of 2017 that imposes a tax on nonprofit organizations that provide transportation benefits to their employees.

Education

The Government Accountability Office (GAO) released a report detailing the underreporting of restraint and seclusion in public schools. The report states that 70% of the nation's school districts reported zero incidents of restraint or seclusion during the 2015-2016 school year. Further analysis found many school districts recorded zero when data was not collected or collected improperly.

Employment:

On June 3, bipartisan Representatives introduced the Customized Approaches to Providing and Building Independent Lives of Inclusion for Transition-aged Youth (CAPABILITY) Act of 2019 (H.R.3070). This bill creates competitive grants for six states to develop pre-employment transition services for people with I/DD that comply with requirements for competitive integrated employment.

In mid-June, the Department of Labor (DOL) Office of Disability Employment Policy (ODEP) created a national online dialogue on the use of subminimum wages under Section 14(c) of the Fair Labor Standards Act. NCCDD submitted comments which reflected North Carolina’s commitment to Employment First and the Council’s 5-year plan goals of increased competitive, integrated employment and financial stability.

NC Congressional Districts:

In June, the Supreme Court ruled (5-4) that partisan gerrymandering was beyond its authority to judge. Based on that decision, North Carolina will not need to redraw its congressional districts prior to the 2020 election. However, each state’s legislatures will again be redrawing their Congressional maps pending the upcoming 2020 census results.

STATE

Legislature  

The Conference Committee that was appointed to work out the differences between the Senate and House budgets produced a budget that was approved by the General Assembly. It included the following:

• Medicaid Transformation Funds: Dollars to support the transition to Medicaid managed care.  Most of this is to pay for the fee-for-service 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 Intermediate Care Facility (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 the Innovations Waiver program to determine what is needed to increase wages to align with wages in Developmental Centers.
• Addressing Unmet Needs in Innovations Waiver: The 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 the Association of People Supporting Employment First (APSE) to develop training to implement supported employment.

The budget did not include Medicaid Expansion, which was a part of the original Governor’s budget and would be beneficial to the upcoming Medicaid Transformation. The Governor vetoed the budget and sent it back to the legislature. As of July 1, the state is running on the current budget until the new budget can be approved. As of the writing of this update, the Senate has left Raleigh and is expected to come back at the end of July.

Medicaid Transformation continues to move forward with Standard Plan expected to launch in November. The approval of a state budget may affect the date, but at this point, the state is continuing to move forward.

• 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. NC Medicaid Managed Care Phase 1 is on track for beneficiaries to begin using their health plan on November 1.

NC Medicaid Managed Care Phase 1 covers counties in regions 2 and 4:

• Region 2: Alleghany, Ashe, Davidson, Davie, Forsyth, Guilford, Randolph, Rockingham, Stokes, Surry, Watauga, Wilkes, Yadkin
• Region 4: Alamance, Caswell, Chatham, Durham, Franklin, Granville, Johnston, Nash, Orange, Person, Vance, Wake, Warren, Wilson

This week, Phase 1 enrollment packets started being mailed to beneficiaries in regions 2 and 4. (Open enrollment for Phase 1 officially begins July 15.)

As a reminder, people who are receiving Innovations Waiver services, on the registry of unmet needs or receiving state-funded I/DD services will not go into the Standard Plan unless they request it. (Innovations waiver services and state-funded IDD services are not available in the Standard Plan.) Until the Tailored Plan is launched, they will continue to receive support services through the LME/MCOs and medical services through the current fee-for-service Medicaid system.

The Tailored Plan is being developed with a projected launch in July 2021. There have been a series of white papers issued.