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Public Policy Update: Governor’s Budget Released, Medicaid Expansion Bill Advances, Medicaid Services Updates

On March 15, the Governor released his budget proposal. It is quite extensive, and in this entry, we have listed some highlights of items that have an impact on many people on the autism spectrum and their families and which address our public policy priorities.

Health and Human Services

  • $126 million for 2,000 more Innovations waiver slots and the outline of a plan to end the Innovations waitlist by 2031 by increasing the number of slots yearly over the next 8 years: 1,800 slots in 2025; 1,800 in 2026; 2,200 in 2027; 2,200 in 2028; 2,400 in 2029; 2,400 in 2030; 2,400 in 2031.
  • $270 million to increase Direct Care Workforce rate to $18/hour, including those in Innovations waiver and other I/DD services, as well as $177 million to increase the personal care service rate by $2.18 per hour to support Direct Support Professional Wage Increases in the PCS and Community Alternatives Programs.
  • $17 million to expand our Transitions to Community Living Initiative; $10 million to expand competitive integrated employment.
  • $100 million for children with complex needs, including at-home care, respite, and community-based services and $11 million for crisis stabilization for children. Many of these children are dually diagnosed with mental health issues and a developmental condition including autism.
  • $5 million to expand competitive integrated employment initiatives (in addition to funding for supported employment services in Medicaid 1915i).
  • $4 million for additional child crisis stabilization services.



  • $196 million to remove the 13% cap on special education funding as well as an additional $57 million to increase baseline education investments.
  • Over 100 million in increases to funding for Specialized Instructional Support Personnel like school counselors, social workers, and psychologists.



  • $150 million for behavioral health and justice system integration, focused on diversion, reentry supports, training for justice systems, which would include those with I/DD.


What does this mean for people on the spectrum? Having large amounts of funding for services for I/DD in the Governor’s budget shows an understanding of I/DD needs and a willingness to fight for I/DD services during the budget negotiations with the North Carolina General Assembly (NCGA). In North Carolina, the NCGA is not required to use the Governor’s budget as a starting point, nor does the governor have line-item veto powers over budget bills, but the Governor’s budget underscores the great needs that people on the autism spectrum have across NC and shows a path toward addressing them.


General Assembly Updates:

Medicaid Expansion: Medicaid Expansion continues to make its way through the legislative process. The NC Senate voted in favor of H76, which will increase Medicaid eligibility for adults making up to 138% of the federal poverty level ensuring that people who fall into the coverage gap between Medicaid eligibility and tax subsidies eligibility under the Affordable Care Act can access affordable healthcare services. The NC House may vote on the revised bill as soon as March 23.

House and Senate leaders announced a few weeks ago that they had reached an agreement on Expansion legislation, but that the bill would be tied to the passage of North Carolina’s two-year budget, which would typically take place before June 30 of this year.  In addition to the expanded health coverage, North Carolina stands to gain more than a billion dollars in additional funding from the Federal government for finally expanding access to Medicaid. The Governor’s office and NC DHHS have already released the outline of a plan for use of the funds (see below).

What does this mean for people on the spectrum? For people on the spectrum who do not have affordable health insurance, they may get healthcare through Medicaid Expansion once this bill passes and the new health care program starts.


Other State Updates

The North Carolina Department of Health and Human Services (NC DHHS) has released a Behavioral Health Plan that outlines how it would use a portion of the Medicaid Expansion “bonus” funding to increase access to mental health, substance use and crisis services. Although I/DD is not specifically mentioned in the brief plan, NC DHHS has publicly stated that their intent is to ensure that people with I/DD have better access to needed crisis support services as well as other I/DD and behavioral health services under any expanded funding from the federal government.


With Medicaid Tailored Plan implementation delayed until October, NC DHHS has given some additional information on changes to Medicaid that will be taking place over the next year, despite the delay.

  • NC Division of Health Benefits (NC DHB) is still anticipating a July 1 implementation date for the start of new 1915i services under our state Medicaid plan. As a reminder 1915i is not a waiver, it is an entitlement service that will offer additional services to anyone with I/DD who is Medicaid eligible and meets the criteria for needing the new services (more info).
  • Medicaid b(3) services offered via the Local management Entities Managed Care Organizations (LME MCOs) will continue to be available for a year following the start of 1915i services. This allows time for individuals getting b3 services to be assessed for additional services thought 1915i and time for transition of services plans to take place between b3 and 1915i providers, if needed.
  • NC’s Unified Waiting List is projected to go live in late summer, before Tailored Plans go live in October. This unified waiting list will contain information on individuals who are waiting for NC Innovations waiver slots, as well as those on any TBI waiver waiting lists which have been managed regionally via LME MCO Registries of Unmet Needs. While LME MCOs will still manage the process for waiver eligibility and distribution of waiver slots, the information about who is waiting will have a single central database.
  • Children in NC Health Choice will move over to the Medicaid program via the Medicaid b waiver, giving them more consistent access to an array of services including Research Based Behavioral Health Treatment (RBBHT) for children on the autism spectrum, as well as other Medicaid state plan services.
  • Individuals on Medicaid who are fully qualified legal residents (sometimes referred to as “legal aliens’”) will also be carved into the Medicaid b waiver, giving them access to a wider array of behavioral and developmental services though the LME MCOs.
  • The Traumatic Brain Injury waiver will expand to Orange and Mecklenburg counties.


What does this mean for people on the spectrum? Even though Medicaid Tailored Plans which will serve many people on the spectrum who have Medicaid health care are delayed until October 1, other Medicaid services will be increased over the next year and programs will expand to include more people with I/DD including autism.



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