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Policy Update: State Budget Delays, Tailored Plan Delays, 1915(i) Services Authorized

Budget Process Halted; State Budget Delayed until at least August

House and Senate Budget Conferees have been named to work out differences between the two versions of the state budget (H259, the Appropriations Act for 2023-2025); however, negotiations have been delayed. Legislative leaders have cited differences over both tax cuts/revenue changes and non-budget legislation, including the state’s medical marijuana bill and gambling casinos, as the reason that House and Senate have not been able to agree on a two-year spending plan.

The existing budget continuing resolution allows state government to continue operating under the previous fiscal year’s budget numbers, but any changes in the budget under debate are on hold. (You can read our report on the comparison of the House and Senate versions of the state budget here.

What this means for people on the spectrum

Any proposed increases in Innovations waiver slots, in wage increases for direct support professionals, and other increases to community-based programs will be delayed until the budget passes. Because the budget potentially includes cuts to some state funded services, LME MCOs may further restrict access to programs with already limited funding until they see a final budget.

Since the expansion of Medicaid coverage to low-income adults (H76) is tied to the passage of a new state budget, this health care program will not begin until the NCGA agrees on a new budget. With the federal public health emergency at an end, Departments of Social Service across NC are required to begin Medicaid “redeterminations” to check on Medicaid eligibility for all current recipients. Those people who are no longer eligible for Medicaid will lose health care coverage while they wait to possibly sign up for an expanded Medicaid program at a later time.

Schools are already expressing concerns about teacher hiring and the high number of teacher and school staff vacancies, since any planned increases in teacher and school staff pay have not yet been agreed on going into the school year.

How can you share your voice on the budget?

Talk to or write your NC state Senators and Senate Appropriations Chairs. Budget delays mean you have additional time to voice your opinion.

  • Email or call your NCGA Senators! 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.
    • Talk about how a lack of services at home or in school is affecting you.
    • Tell them how critical DSP wage increases are to getting access to services!
    • Ask them to pass a budget SOON that makes investments in people on the autism spectrum, like waiver slots, education funding, housing, and/or ask for services and supports that you need.
  • The NCGA website will help you identify who represents you. Be sure to check the circles at the top of the map for “NC Senate” and “NC House of Representatives” to see who represents you in the NC General Assembly’s Senate and House.
  • In addition to your own NCGA Legislators, please contact the NCGA Budget Conferee Chairs listed below to advocate for better investments in people on the autism spectrum, including more services and better education funding. You can find the full list of budget Conferees here to see if your own legislator is on the committee.


House and Senate Budget Conference Committee Chairs

Senator Ralph Hise representing Madison, McDowell, Mitchell, Polk, Rutherford, and Yancey
Office Phone: (919) 733-3460 Email: Ralph.Hise@ncleg.gov

Senator Brent Jackson representing Sampson, Duplin, and Johnston
Office Phone: (919) 733-5705 Email: Brent.Jackson@ncleg.gov

Senator Michael V. Lee representing New Hanover
Office Phone: (919) 715-2525 Email: Michael.Lee@ncleg.gov 

Representative Donny Lambeth representing Forsyth
Office Phone: (919) 733-5747 Email: Donnie.Lambeth@ncleg.gov

Representative Dean Arp representing Union
Office phone: (919) 715-3007 Email: Dean.Arp@ncleg.gov

Representative Jason Saine representing Lincoln
Office phone: (919) 733-5782 Email: Jason.Saine@ncleg.gov


You can view the state budget proposals by going to the North Carolina General Assembly webpage and checking out the link to “2023 budget” on the left side of the home page under “News and Information.” “Bill text” is the entire budget document including the special provisions and “Committee Report” is the information on specific line items in the budget, sometimes referred to as the money report. Please note before printing that budget documents are hundreds of pages long.



Tailored Plans Delayed, Again

NC Department of Health and Human Services (NC DHHS) announced that the new Medicaid Tailored Plans, specialized health care plans under Medicaid for those with intellectual and/or developmental disabilities (I/DD) including autism, as well as those with significant mental health or substance use disorders, due to start on October 1, would again be delayed. Citing concerns about provider network adequacy, budget uncertainty, and the need for adjustments to the laws governing LME MCO operations, NC DHHS has delayed implementation for Tailored Plans and given no specific date when they would start (read the NC DHHS announcement). New programs in Medicaid for people with I/DD, including Tailored Care Management which began in December of 2022 and 1915(i) services which began on July 1, 2023, will continue to move forward. More info on the start of 1915(i) services is included below.

What does this mean for people on the spectrum?

Even though the start of Medicaid Tailored Plans is delayed, Medicaid and the LME MCOs will continue to provide Medicaid services to people on the spectrum who have Medicaid health care. Other Medicaid services will be increased over the next year and programs will expand to include more people with I/DD including those on the autism spectrum.


1915(i) Services under Medicaid Begin July 1, 2023

As of July 1, the Centers for Medicare and Medicaid Services (CMS) has authorized North Carolina to begin offering new services for people on Medicaid with I/DD, as well as those with mental illness and substance use disorders. Over the next year, 1915(i) services will replace (b)(3) services offered by the LME MCOs. Unlike (b)(3), 1915(i) services are an entitlement. This means the program does not keep waiting lists and does not run out of funds to help people. If you are Medicaid eligible, even if you did not get (b)(3) services you may be eligible for new services under 1915(i). Check with your tailored care manager or LME MCO care coordinator for more info on getting assessed for 1915(i) services.

You can read more about 1915(i) in this blog and in our next edition of the Spectrum due in September. As the new program rolls out, ASNC will publish additional updates on how to access these new services and answer commonly asked questions.

What does this mean for people on the spectrum?

If you or your family member has Medicaid as health care, you may be able to access services that were not available before. People with Medicaid do not need to meet “institutional level of care criteria” to get 1915(i), so if you did not qualify for Innovations, you may still be able to get some 1915(i) services. You can get 1915(i) services and remain on the wait list (Registry of Unmet Needs) for Innovations.



ASNC continues to monitor the progress of the budget, provide feedback to legislators and state government on how these proposals affect people on the autism spectrum, their families, and those that serve them. If you have questions about the budget proposal, 1915(i) services, Tailored Plans or other public policy issues please contact Jennifer Mahan, Director of Public Policy, at jmahan@autismsociety-nc.org.

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