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Public Policy Update: Rate Increase to Support Wages for Direct Support Workers A First Step in Right Direction

The state budget that passed in December 2021 included funding towards increasing Medicaid home and community-based provider rates so that wages paid to direct support professionals/direct support workers can be increased. While the budget special provision language states that 15.00 per hour is the goal, there is not enough money appropriated in the budget to reach $15.00. In some cases, the increase will simply make up for an already planned decrease in Medicaid rates for home and community-based care.

Why are Medicaid rates decreasing? Why will hourly wages not reach $15?

At the start of the pandemic, state and federal governments raised Medicaid rates temporarily to help pay for COVID infection precautions and to retain health care workers in many (but not all) Medicaid services. Some programs for home and community-based care were not included in the rate increase, and some were, making the temporary rates increases very confusing and inequitable. Some providers, including ASNC, used the increased rates to increase wages paid to attract and retain DSPs and other staff. As the pandemic ends, those temporary rate increases will end.

Rates for many I/DD services have not changed in over a decade. ASNC and a coalition of aging, disability services organizations, and DSP advocates have been pushing for rate and wage increases, including support for HB 914 Support Our Direct Care Workforce, which would have allocated $160 million in state funds to draw down an additional $334 million in Federal matching funds to move DSPs to a minimum of $15 dollars an hour. Disability advocates questioned if $160 million would be enough given the large number of services that utilize DSPs and the rising cost of health care, labor changes, etc.

The NCGA included $68 million recurring in state funds for rate increases in the budget, not the $160 million that H914 said was needed. This $68 million will draw down another $141 million in Federal funds with North Carolina’s enhanced federal match: a significant step in the right direction but less than what is needed.

The budgeted funds will be used to increase rates; HOWEVER, at the same time these new rates are going into effect, the existing rates are set to go down by 7-10% due to the expiration of temporary COVID rate increases between April and June. The NC Department of Health and Human Services sets the rate floor, or the minimum a provider must be paid for the service. LME/MCOs and other managed care organizations managing Medicaid benefits can adjust those rates higher. At least one is piloting a program to adjust rates to providers who in turn pay a minimum of $15 per hour for some Medicaid services. Note that since the LME/MCOs have rate setting authority, rates per service, and wages may vary from MCO region to MCO region in the state.

With COVID rate increases ending, the new rate funding will in most cases be needed just to maintain the current rates paid to providers, and in some cases may be even lower than the COVID rates. The rate increase will simply prevent a cut to existing COVID rates, in most cases. ASNC is grateful that we may not have to institute any cuts to existing services and wages as a result of the loss of temporary rate increases, but the state budget rate increase will be unlikely to change DSP pay in the short term.


What is needed and how you can help:

This is an important issue for our community. Please make time to reach out to your legislators and:

  • Thank them for their attention to DSP wage problems and for supporting the first step to a $15 per hour wage.
  • Ask for their support for the full funding outlined in HB191 with at least $160 million ($100 million more than the 2021-2023 budget) in state funding needed to get us closer to $15 per hour.
  • Advocate for inflationary increases to home and community-based funding, similar to the way state developmental centers and other state operated services are funded.
  • Advocate for the state to expand Medicaid to close the insurance coverage gap.¬†If NC expands Medicaid to those without access to affordable care, we will get additional funding form the federal government to support home and community-based services, which can include raising the wages of DSPs


The following are suggested talking points for your messages to legislators:

  • ‚ÄúThank you for the most recent budget that highlighted the many needs of people with autism.‚ÄĚ
  • ‚ÄúI‚Äôm concerned about the low wages being paid to direct support workers for people with autism. The recent Medicaid rate increase is not enough to get wages to $15.‚ÄĚ
  • Tell the legislator about how this issue is affecting you personally. Examples:
    • I want to continue to work in Direct Supports with people on the spectrum but wages are too low to live on.
    • My provider agency can‚Äôt hire support staff for my family member because people can make more working in retail or fast food. DSP staff have left to take higher paying jobs.
    • My loved one can‚Äôt remain in community setting/apartment/home without staff.


How can you share your voice?

  • Email or call your NCGA members! Prepare a short statement using our Advocacy Tips Sheet or Advocacy 101 Toolkit. BE BRIEF, BE RESPECTFUL.
    1. Introduce yourself and how you are connected to autism.
    2. Use the messages above to talk about how the DSP crisis is affecting you.
  • Tell them about the importance of high-quality, consistent, caring staff.
  • Record a short video talking about #lifewithautism and #invisibleheros and how access to services helps.
    1. 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.
    2. 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 ‚ÄúNC House‚ÄĚ and ‚ÄúNC Senate‚ÄĚ to see who represents you in the NC General Assembly.

In addition to your own NCGA member, please also contact the NCGA Budget Chairs listed below to advocate for increase wages for Direct Support Staff/Direct Support Professionals.

Appropriations Chairs

Senator Kathy Harrington representing Gaston
Office Phone: (919) 733-5734 Email: Kathy.Harrington@ncleg.gov


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


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


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


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


Representative Dean Arp representing Union
Office Phone: 704-282-0418   Email: Dean.Arp@ncleg.gov


HHS Appropriations Chairs

Senator Jim Perry representing Lenoir and Wayne County
Office Phone: (919) 733-5621 Email: Jim.Perry@ncleg.gov


Senator Joyce Krawiec representing Forsyth and Davie
Office Phone: (919) 733-7850 Email: Joyce.Krawiec@ncleg.gov


Senator Jim Burgin representing Harnett, Johnston and Lee
Office Phone: (919) 733-5748 Email: Jim.Burgin@ncleg.gov


Representative Kristin Baker representing Cabarrus
Office Phone: 919-733-5861   Email:  Kristin.Baker@ncleg.gov


Representative Larry Potts representing Davidson
Office Phone: 919-715-0873   Email: Larry.Potts@ncleg.gov


Representative Wayne Sasser representing Stanly, Cabarrus, Rowan
Office Phone: 704-982-8003   Email:  Wayne.Sasser@ncleg.gov


Representative Donna White representing Johnson
Office Phone: 919-889-1239   Email: Donna.White@ncleg.gov



Please contact Jennifer Mahan, ASNC Director of Public Policy, jmahan@autismsociety-nc.org for assistance connecting with your elected officials and other questions about advocacy.

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