State Budget Update: The NC Senate passed SB 105, their version of the state budget bill, on Friday, June 25. This year’s budget contains a mix of state appropriations and allocations of federal funding that has come to North Carolina through several “recovery act” bills. The NC House is expected to release their budget bill sometime in mid-July. The House and Senate will have to reconcile differences between their budget bills though the conference committee report before sending the final budget to the Governor.
Several Senate Democrats joined Senate Republicans voting in favor of the bill, hinting that a potential Gubernatorial veto of the budget (which happened two years ago) could be overridden by one or both chambers. With the slow pace of the budget process this year, we may not see a final budget until August.
Up-to-date budget legislation, special provisions and committee reports can be found on the NC General Assembly’s home page in the left column. Note that the budget is divided into two documents: 1) the budget bill itself, which includes the language of the “special provisions” that provide guidance on how funding is to be used and dictates additional policy changes and 2) the committee report, often called the “money report,” which provides some detail on spending increases and decreases in each budget area.
Senate Budget Highlights
Adds 1,000 Waiver Slots: The budget includes $7 million/$25 million recurring funding for a total of 1,000 new Innovations waiver slots over the two years of the budget. While this funding reflects the two appropriations bills (SB 350 / HB 389), advocates had pushed for the budget to include a minimum of 2000 slots (1000 per year) to begin to address the 15,500 individuals on the registry of unmet needs (registry). There are currently about 750 new people being added to the registry every year.
Adjustments to Waiver Distribution: The budget special provisions earmark 280 slots to be distributed on a per capita basis using each Local Management Entity/Managed Care Organization (LME/MCO’s) catchment area population. The remaining slots would be distributed based on the current formula, which has created longer waits for waiver services in some counties.
Waiver Flexibility to the Division of Health Benefits (DHB): The waiver special provision also gives flexibility to state DHB (Medicaid) to come up with new ways to serve individuals on the registry including new waivers or a tiered waiver system, within the available Innovations waiver funding.
ICF-I/DD Direct Support Worker (DSP) Wages: Allocates $17.5 million to increase the wages of DSPs working in Intermediate Care Facilities (ICF) for people with Intellectual and/or Developmental Disabilities (I/DD). The legislation requires that 80% of funds allocated to ICF providers go to wage increases. This wage increase only affects ICF-I/DD and does not include other community-based services or waivers. The budget also includes $12 million in additional temporary funding for ICF-I/DD providers.
One-time DSP Bonus: Allocates $100 million dollars in federal recovery funding in Medicaid to distribute one-time $1,500 bonuses to certain eligible direct support workers employed by providers enrolled in Medicaid or NC Health Choice. (No other details were available for this budget item)
LME/MCOs Retain Funding: LME/MCOs would retain $30 million in funds that in previous budget years have been transferred to Medicaid Reserves or the General Fund. This provision begins to restore $500 million in funding that was removed from the LME/MCO system over the last 8 years.
Special Assistance Personal Needs Increase: The state special assistance personal needs allowance will be raised from $46 per month to $70 per month.
Students with Disabilities Enrollment Reserve: Adds $40 million to a fund for public schools to use if enrollment of students with special needs exceeds anticipated enrollment. Note that the 12.75% cap on special education funding for school districts remains in place in the Senate’s budget bill and this additional enrollment funding still cannot exceed this cap.
Special Education Due Process Hearings: Bill language from SB 593 has been added to the Senate Budget special provisions. The original bill, SB 593 Special Education Due Process Hearings, would change the state’s process for special education due process appeals by ending the practice of appealing cases to a special education Review Officer and allowing for parents to file civil cases in state or federal court following the decision of an administrative law judge. Almost no appeals were won by families using the Review Officer process, and this change allows for a more impartial appeals process in court. If this language remains in the budget through the negotiations, it would be enacted when the budget passes.
Community College I/DD Pilot: adds $250,000 for an additional 2-year community college program to serve individuals with intellectual and/or developmental disabilities designed to increase their employment and independence.
The following items were NOT included in the Senate’s budget
The language from HB 249 Children with Disabilities Funding Formula bill and any general increases to special education funding were not included. HB 249 would have directed DPI to study the funding formula for children with disabilities and special education in public schools including the benefits of a model that based funding on the severity of disability type and increases the cap on the current funding formula for children with disabilities from 12.75% to 13%.
Development of a Ten-Year Plan for Registry: HB 389 and SB 350 – North Carolina Innovations Waiver Act of 2021 – included language requiring NC DHHS to convene a stakeholder group to develop a ten-year plan to address the registry of unmet needs aka those waiting for innovation waiver services. NC is currently developing a new Olmstead Plan to address the delivery of community services across I/DD, mental health, and substance use populations, which we hope would also make recommendations for the resources to address the lengthy registry.
Health Care Coverage Gap in NC: the Senate budget does include funds in extend coverage for post-partum women for 12 months, and to allow parents of children in foster care to retain coverage if they meet certain requirements, but does not address the overall gap in affordable health coverage for those who do not get health care tax subsidies or qualify for Medicaid.
Direct Support Staffing Crisis: Recurring funding to pay competitive wages to direct support staff across community-based services was not included. This issue was outlined in HB 914, Support Our Direct Care Workforce. This increase is KEY to having viable community-based services like those provided in Innovations waivers.
How you can help – Take action!
We are pleased that legislators are starting to recognize the need to address the 15,500 people on the waiting list for services. While 1,000 new slots is a start, it is not enough to address the growth of people on the list, let alone the 10+ year wait for services in some areas. Access to waivers must also go hand in hand with competitive wages for direct care staff – or there will be no one to provide the service.
Please contact House Budget Chairs (see below) and your House Legislator to advocate for the following budget priorities:
- Add a minimum of 2,000 Innovations waiver slots and commit to fund additional services to address the registry of unmet needs.
- At least $160 million in recurring funding to increase the wages of direct support staff across community services so the new waiver slots (and other services) have staffing.
- Recurring funding for special education and an elimination of the artificial cap on special education funds to local school districts.
- Other services and supports YOU need. See our list of legislative targets here.
How to advocate:
- Email or Call your NCGA members! Prepare a short statement using our Advocacy Tips Sheet or Advocacy 101 Toolkit. BE BRIEF, BE RESPECTFUL.
- Introduce yourself and how you are connected to autism.
- Tell them your story of how having, or not having, services is affecting you.
- Tell them about the importance of high-quality, consistent, caring staff.
- Record a short video talking about #lifewithautism and how access to services helps.
- If you have services talk about the importance of high-quality, consistent, caring staff, an increase in waiver slots and support of other needed budget items (see above). If you do not have services, talk about what it would mean for you get them.
- Post the video on your social media accounts and tag your NCGA elected officials.
The NCGA website will help you identify who represents you. Be sure to check the circles at the top of the map for “NC House” and “NC Senate” to see who represents you in the NC General Assembly.
In addition to your own House member, please also contact the leaders of the House Budget listed below to advocate for better services, supports, and education for those on the autism spectrum.
Health and Human Services Appropriations Chairs (services, waivers, health care):
Education Appropriations Chairs (schools, education funding):
Please contact Jennifer Mahan, ASNC Director of Public Policy, firstname.lastname@example.org for assistance connecting with your elected officials and other questions about advocacy.
Tags: ASNC, autism, autism health care, autism legislation, autism Medicaid Services, medicaid, NC state budget, ncga, North Carolina General Assembly, public policy