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House Budget Proposal Released, Includes 1915 b/c Managed Care Waiver


Budget: The General Assembly House Appropriations Sub-committees released their budget proposals and budget special provisions last week.  In most cases, sub-committees used the Governor’s budget cuts as a starting point and then cut an additional 1.6 billion dollars from the state budget for a total reduction of 2.5 billion dollars from the base budget. Cuts include $1.3 billion from public education, $527 million from Health and Human Services and $142 million from Justice and Public Safety.  The House budget proposal is $800 million below the projected revenue amount; leaving the possibility that additional tax cuts will be proposed along with the massive cuts to state services.

Overall, the cuts to developmental disabilities could have been worse, but the deep cuts to education, other human services and support services will result in services lost, jobs lost, and set the state back decades in its efforts to move forward in education, health and public safety. Budget writers have left millions on the table that can be used to take a more balanced approach.  Budget cuts that could impact people with autism spectrum disorder and other developmental disabilities are described below and a list of some specific line items follows. Because sub-committees are still making changes, some of the numbers below reflect recent changes in the document that may not yet be listed on the GA website.

Proposed Cuts: House budget proposals include $3.5 million in cuts to early intervention, $20 million in cuts to state funded service dollars, also called Integrated Payment and Reporting System (IPRS) funds which are administered at the Local Management Entity level to deliver services such as Developmental Therapies, and $25 million in IPRS service dollar cuts that are to be made up through the use of Local Management Entity fund balances. Medicaid was cut by $375 million. Some cuts are expected to be made up for with funds from the Federal government and use of “medical homes,”  which increase care coordination resulting in use of fewer and lower cost services. However, if the “savings” cannot be found, the North Carolina Department of Health and Human Services (NC DHHS) is authorized to reduce or eliminate optional Medicaid services. Cuts to Medicaid result in the loss of Federal matching funds at a $3 to $1 ratio.  Medicaid providers, except doctors and nursing homes, will not get inflationary increases and instead see a rate reduction in the range of 2%.  Included in House budget special provisions is language that would prevent anyone on Medicaid from receiving services funded by IPRS dollars, with the exception of those needing residential supports.

Another area of great concern is the massive cuts to education, including early childhood programs like Smart Start and K-12 education. While there is no specific cut to special education, these cuts will impact the availability of developmental and health screenings in local communities and educational support in primary education.  The cuts have the potential to result in the loss of 21,000 positions including teacher assistants and non-instructional support like guidance counselors and school psychologists, putting more pressure on teachers for children with ASD who are in mainstreamed classrooms. 

Managed care: The budget special provisions include language that expands 1915 b/c combination managed care waivers for people with developmental disabilities including ASD. Particularly troubling, the budget finds savings of $3.2 million in year one and $38 million in year two of the budget from the implementation of these waivers. According to waiver guidelines, savings are not to be removed from the system, but are to be re-invested in the system to provide better access to services and supports for those waiting for help.  The Autism Society of North Carolina is concerned that managed care waivers will move forward without public input, will eliminate independent case management, and will result in a loss of services for people with autism spectrum disorder rather than ensuring we reduce waiting lists. 

ACTION: The House budget will be voted on in the next week. Call, email or visit your Legislator to express your concerns!

  1. Let your legislator know how budget cuts and managed care will impact you and your family.
  2. Urge legislators to take a balanced approach to the budget and preserve vital services and supports, including education. 
  3. Tell them that managed care needs to include public input, independent case management, a continuum of quality service and support options for people with autism, and protections for individuals’ rights. Savings should come from administrative efficiencies not reduction in services.
  4. Attend Autism Awareness Day at the General Assembly on May 3rd. Go to the ASNC website for more info and detail on how to register.
  5. The General Assembly website at has info on who represents you. You can call the General Assembly  switchboard at 919-733-4111 to contact your Legislator.  

Budget Cuts by Department: This is not a complete list of cuts; for more info please see for specific budget line items. Cuts are indicated by parenthesis ().

Department Fiscal Year 2012-2013 Fiscal Year 2011-2012

DHHS Admin



Non-Profit Funding



CARELINE (handles calls for help, including Medicaid problems)




Div Child Development



Smart Start



Discontinue transport



Div of Public Health



Early Intervention



Div of Medical Assistance



Modify Optional and Mandatory Services (total of several)



Eliminate inflationary increases



Adjust provider rates



Behavioral Health 1915 b/c waiver (includes DD, autism)



CCNC savings (implementing more medical homes)



Div of Mental Health, Developmental Disabilities, Substance Abuse



Eliminate 7 advocacy positions (in state facilities)



Eliminate Community Funding (IPRS) for Medicaid recipients, except residential support



Swap (LME) fund balance w/ state service funds



Reduce Division management flex funds (emergency fund)






Public Schools Total Cuts



LEA adjustment (schools return funds to state, make cuts locally)



Eliminate TAs (except K-1)



Community Colleges  Total enrollment growth funded, but tuition increased and all programs cut



University System Total enrollment funded, but 470 mil flex cut to be determined by UNC




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No Responses

  1. Don Agel says:

    1. Education lottery was supposed to fund part of the educational system in this state. Where is that money going? Yet educational funds are being cut. Yea, let us cut education. It only affects future generations, not ours right? Selfish! That is stealing from our children as well as the advancement of humanity.
    2.For any developmental services or early intervention program to have funds cut would be a downward spiral on spending for those affected. $2000 for each developmentally challenged youth/toddler/infant being cut now may save money initially but the end results are special needs individuals who are not functioning members of society contributing to the economy, but rather individuals who may still need assistance and special care costing well over $4000 a month! So save pennies now to spend billions later. Brilliant!!!! That kind of budget cut is called \”help this generation of adults and scar many generations to come\”.

    I pray that these people not only reconsider these cuts but make cuts that affect this generation not many generations to come. It is time to answer our problems now rather than letting them fester and grow, and then passing them on to other generations.

  2. mahanjk says:

    I too hope that the Legislature reconsiders these cuts and ASNC encourages you an anyone reading these responses to pass along your thoughts to your NC General Assembly Legislators as well as the Leadership of the NC House and Seante.

  3. […] reducing Senate proposed cuts down to the House levels.  We reported on the House budget in our blog post  and a chart outlining the final cuts in the compromise budget is below. All in all while these […]

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