A closer look at the NC budget and its impact on the autism community

Photo credit to Mr. T in DC via Flickr.com

Photo credit to Mr. T in DC via Flickr.com

Every two years, the NC General Assembly passes legislation that sets a budget for the state over a two-year period, this year from July 1, 2013, to June 30, 2015. When the General Assembly returns in May 2014, legislators will make some adjustments to the budget, but they will not redo the entire bill.

The budget documents are in two parts:

  • the actual bill listing general funds appropriated to each department/area along with special provisions and policy changes that direct the use of the funds
  • the “money report” or conference report that provides some detail about funds that were added or removed from each department’s budget

Links to the budget documents can be found in the left column at www.ncleg.net. Because the budget and the technical corrections bills were passed at the end of July, it may be several weeks before the technical corrections are merged into the final bill and the budget can be seen in its correct and complete form.

The Autism Society of North Carolina continues to advocate for increased access to quality services and supports, including for those on waiting lists and those who do not have access to health insurance or services through their health insurance. No new initiatives for people on the autism spectrum or with any developmental disabilities were funded in the new budget, nor were any additional Innovations (formerly CAP-IDD) funds added. The General Assembly did not authorize or fund an “i” option allowing for new basic level of services to be developed.

Appropriations bills

House Bill 5: Temporary Funding of Group Homes and Special Care Units: In the opening days of the 2013 session, the legislature passed a temporary funding bill for group homes (so-called “5600 DDA” group homes) for people with intellectual and developmental disability and mental illness.

Department of Health and Human Services (DHHS) Budget

  • Base Budget for the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services (MHDDSAS): The division’s base budget allocation was funded in the final budget, which included restoration of the $20 million in nonrecurring cuts to state-appropriated services (IPRS funds). 
  • ASNC Nonprofit Funding for Direct Services: The budget provides for funding for not-for-profit organizations that provide service programs. As of this writing, ASNC retained 88% of its current funding. The budget also includes a special provision that will introduce a competitive grant-making procedure for funding that will begin in fiscal year 2014-2015. The timing of the grants and the allocation is critical, and we are monitoring the development of this new process by DHHS.  
  • Group Home Funding: $4.6 million one-time funding as temporary support to group homes whose residents lost personal care services under a restructuring of personal care services funded by Medicaid. This funding amount comes directly from DHHS and the Division of Medical Assistance. Also, a special provision directs DHHS to present a long-term fix for the personal care services needed in the 5600A and C group homes, including the possibility of a tier structure for special assistance payments. 
  • Developmental Disabilities Block Grant Funding (SSBG): This funding had been incorrectly eliminated during the current state budget and was restored at the beginning of the 2013 legislative session. MHDDSAS adult funding was set at $4,030,730 for each of the two fiscal years.
  • Guardianship Funding: Social Services block grant funding of $3,978,360 for fiscal year 2013-2014 and $3,978,360 for fiscal year 2014-2015. Based on our first review, it looks like this funding took a cut of slightly over 7% because of federal funding cuts.

Of continuing concern to ASNC are the cuts to Children’s Developmental Services Agencies (CDSAs) in North Carolina that could result in some closures of sites. Budget writers have been critical of state programs that did not use all of their funds in the current budget year. The CDSAs did not use some funds because of hiring freezes and difficulty in hiring because of pay differentials. More education of legislators is needed on the importance of early intervention services, the types of services that should be offered, and the reasons some funds go unused.

Child Development Centers Closing

The final budget agreement does reduce the state-funded appropriations to CDSAs by $8 million in nonrecurring funds for fiscal year 2013-2014 and by $10 million in recurring funds in fiscal year 2014-2015. Because of the cuts, the Department of Health and Human Services, Division of Public Health, may close up to four CDSAs, effective July 1, 2014. The bill instructs the department to retain the CDSA in Morganton and the CDSAs with the highest caseloads of children residing in rural and medically underserved areas. If the department elects to close one or more CDSAs pursuant to this section, it must submit a report to the Joint Legislative Oversight Committee on Health and Human Services and the Fiscal Research Division no later than March 1, 2014, identifying the CDSAs selected for closure.

Budget Special Provisions

The budget often contains policy changes in the “special provisions.”

  • Medicaid Reform Special Provision: The provision creates a Medicaid Reform Advisory Group – made up of five appointees – to advise DHHS in its creation of a proposal for “significant reforms” to the state’s Medicaid program. It authorizes DHHS to create a predictable and sustainable plan that increases administrative ease and efficiency of the system and also addresses the “whole person” by integrating physical and behavioral health care. DHHS may submit drafts of the plan to the federal government for feedback prior to the March 17, 2014, reporting deadline to the General Assembly, but it cannot submit any forms for implementation until the General Assembly approves the plan. 
  • Prior Authorization of Mental Health Medications: Early in the budget process, budget writers intended to create a prior authorization (PA) process for all mental health medications, such as those to treat anxiety, depression, and psychosis. These medications had been exempt from PA because data has shown PA can interfere with people accessing medications, resulting in higher costs for hospitalization and law enforcement. The budget technical corrections bill changed the PA language to focus only on medications for ADD and ADHD prescribed to juveniles because of high costs and concerns about misuse/misprescribing. Given the number of children with autism who are also diagnosed with a mental health disorder, ASNC will continue to monitor the implementation of PA.
  • The budget contains 215 cuts to teaching assistants and flexibility for Local Education Agencies (LEAs) in removing caps on class size. Some funds that had been removed from LEAs were returned. LEAs will have flexibility in how funding cuts are implemented at the local level.

If you have questions about the budget or other public policy issues, please contact Jennifer Mahan, Director of Advocacy and Public Policy, at 919-865-5068 or jmahan@autismsociety-nc.org.

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