ASNC Day on the Hill

 

capitol-hill

This article was contributed by Jennifer Mahan, Director of Advocacy and Public Policy.

The Autism Society of North Carolina traveled to Washington, D.C., to participate in the Autism Society of America’s annual Day on the Hill for Autism Society advocates. Our goal in participating this year was to make sure that we voiced to Congress the critical need for services and supports for people of all ages on the autism spectrum, as legislators consider affordable health care access, Medicaid funding, and education issues.

ASNC Director of Policy Jennifer Mahan met with staff from our congressional delegation on Capitol Hill February 16 to discuss our concerns about affordable, comprehensive health care; Medicaid’s importance to people with disabling conditions; the need for adult services including employment supports and housing; and the right to a free appropriate education that meets the needs of students with disabilities.

Many of our current members of Congress are aware of autism issues, as well as the work of ASNC, based on their connections to constituents, families and ASNC’s long history of service in NC. Despite this familiarity, with so many changes happening on a national level it is more important than ever for all of us to make the connection between the policy decisions faced by our members of Congress and the impact of those decisions on the lives of people with autism and their families.

 

What You Can Do

  1. Learn who represents you and North Carolina in Congress.
    • You are represented by two US senators, Richard Burr and Thom Tillis.
    • You are represented by one member of the US House of Representatives, based on where you live. You can find out which US House member represents you by entering your street address on the THIRD map at the bottom of this page. (Please note that only the third map on this page is for Congress. The other maps are for the NC General Assembly.) Or you can call the Congressional Switchboard at 202-224-312 for info on your members of Congress.
  2. Tell your representatives about your experiences with autism, as a person on the spectrum, as a family member, as a professional, as someone who cares:
    • Call or email. Handwritten letters take weeks or months to reach Congress because of security measures. Calling or emailing is better. Better still is inviting your member of Congress to a local autism event or local service organization to see things firsthand.
    • Say you live in their district. (OR for your two senators, say that you live in NC).
    • Tell them the basics: who you are, how autism has affected you, why the issue is important, and why retaining or getting access to health care and education services has helped. Keep it to the equivalent of a page or a five-minute conversation. Short summaries are more likely to generate questions and interest in your issue.
    • Be respectful and positive, but firm. Ask for what you need. Some talking points are below. See our toolkit Advocacy 101 for more on working with elected officials.

 

Talking Points to Advocate on Issues that Matter

We know that health and disability issues can be complex. Below are some points that you can use in your discussions with Congress. MOST IMPORTANT is telling your story about autism and what is working or what could be improved with the help of your member of Congress. You don’t need to be a policy expert!

  1. The Affordable Care Act/“Obamacare”
    • The ACA should not be repealed without a plan for replacement that maintains or improves access to health care.
    • People with autism have benefited from parts of the ACA that require coverage for pre-existing conditions, the ability to stay on families’ health-care insurance until the age of 26, and the ability to buy affordable coverage on the health marketplace.
    • Autism is a complex disorder that often includes other physical and neurological conditions.
    • Any health-care package must include both rehabilitative AND habilitative services, mental health and addiction services coverage, behavior treatment, and prescription drug coverage.
    • Because of changes in the ACA, North Carolina has dramatically improved access to children’s health care, which improves access to developmental screening, early identification of autism, and early interventions.
    • Health care must be affordable and address high cost-sharing requirements and high premiums. Many families already struggle with added costs of raising a child with special health needs. Many adults on the spectrum are unemployed or under-employed, so age cannot be the only factor in determining health-care subsidies.
  2. Medicaid
    • Medicaid provides health-care services, long-term care services, and other supports that maintain health, functioning independence, safety and well-being to an estimated 500,000 children and adults with disabilities in North Carolina.
    • State Medicaid programs provide critical screening, early intervention, and home-based health programs for children with autism under Early and Periodic Screening, Diagnostic and Treatment (EPSDT). Early screening, diagnosis, and intervention are critical to preventing long-term disability.
    • NC is already doing a good job with its federal Medicaid funds: NC has used managed-care principles, prevention services, and health data to effectively manage Medicaid costs.
    • Do not cut Medicaid funding. Program cuts, along with block granting or per capita caps would hurt people with autism who rely on Medicaid for essential services. These costs get passed along to beneficiaries, families, and providers who are already doing more with less.
    • Additional cuts or restrictions on Medicaid funding could prevent NC from addressing the 12,000 people with developmental disabilities, including autism, on NC’s Medicaid waiver waiting list.
  3. Education
    • The Individuals with Disabilities Act (IDEA) and the Every Student Succeeds Act (ESSA) ensure that students with disabilities get the education they need and that schools are subject to a strong accountability system to ensure all students succeed.
    • IDEA is parent-driven: parents ask for evaluations, participate in planning, and can access procedural protections to ensure that their child is able to learn.
    • The federal IDEA act is not perfect, but it is assuring families that their child is able to attend school and get access to the curriculum in the least restrictive environment. It is CRITICALLY important to assure these rights for students with disabilities.
    • Schools are already challenged to meet the needs of students with disabilities: right now only about 15% of the funding for educating special needs students comes from the federal government though much more was promised. Please fully fund special education.

 

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

 

 

 

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2016 Legislative Wrap-Up: The Budget

GA Front

This article was contributed by Jennifer Mahan, Director of Advocacy and Public Policy at ASNC. It is the first of three parts wrapping up the NC General Assembly’s 2016 short session.

The NC House and Senate agreed on a budget adjustments bill for the second year of the state’s two-year budget, which allocates a total of $22.34 billion across state services including education and health and human services. The 2016 budget adjustments spend less than 3% over what the 2015-2016 budget provided and only adjust the second year of the biennial budget. The budget includes funds for the state’s rainy day account, teacher and state employee raises, additional K-12 students with disabilities scholarships, and 250 additional Innovations home and community waiver slots, while reducing the base budget for Medicaid to reflect lower projected costs for healthcare services. Changes to tax revenue were addressed in a separate bill, which broadens the sales tax base and lowers individual income taxes by increasing the standard deduction from $1,000 to $2,000 through next year.

The $152 million planned cut to single-stream funding for mental health, developmental disabilities, and substance abuse services (MH/DD/SA) remains in the budget. Last year, $120 million was removed with a provision to restore $30 million if targets were met by the end of the 2015-16 fiscal year in June. Those targets were met, and the $30 million restored. The same budget provision remains in place for this year: if targets are met, $30 million will be restored at the end of 2016-17. However, the overall cut remains at an additional $152 million from LME/MCO reserves, typically used for services to people without other health-care options.

There are a few special provisions that target issues for the intellectual and/or developmental disability (I/DD) community including a comprehensive look at federal and state changes to the I/DD system, a strategic plan to address behavioral health in NC that looks at gaps in the LME/MCO system, and a study on the rates paid for certain types of services. As we look toward the 2017 budget process, single-stream dollars will have a significant deficit that could affect direct services across the state. Overall, the health and human services budget attempts to address key priorities from the General Assembly and the governor with small expansions to crisis funding, waivers, and disability scholarships and the preservation of existing autism services in Medicaid and through the nonprofit funding sections, but no large-scale expansion of services or special education funding.

The full budget bill with special provisions and conference reports listing specific dollar amount changes can be viewed at www.ncleg.net; links to budget documents are in the left column. The overall budget includes technical corrections made in House Bill 805 that may not be included in the ratified version of the budget until after it is signed into law. In the sections below where “recurring funds” are mentioned with an R, this means that the program will be funded in an ongoing way (at least for the next year and hopefully into future years) and “non-recurring” noted with an NR indicates that funds are one-time and only for the 2016-17 fiscal year.

 

Health and Human Services Budget

Innovations waiver slots: The final budget includes $2.6 million (R) for 250 Innovations home and community-based waiver slots (formerly CAP-IDD) to begin opening January 1 2017, which were included in the governor’s budget proposal. Innovations 1915 (c) waivers provide services to people who qualify for institutional level care because of intellectual or developmental disabilities, but can be served under a community-based program in their homes.

Replacement of LME/MCO single-stream funds: $30 million will be restored to single-stream funding which is used for MH/DD/SA services and individuals that are not eligible for Medicaid. An additional $30 million will be made available if there is a surplus in the Medicaid budget. This is well short of the $120 million and $152 million removed in budgets last year and this year.

Governor’s Task Force recommendations: The budget reserves $10 million (R) and $10 million (NR), to implement the recommendations of the Governor’s Task Force on Mental Health and Substance Use. The funds shall be held in the Mental Health and Substance Use Task Force Reserve Fund, will not revert, and shall remain available until expended. The task force recommendations include increasing access to child crisis services.

Dix property and crisis beds: The budget includes provisions for the sale of the Dorothea Dix Hospital property: $18 million and $2 million in funds will go toward increasing access to behavioral health care hospital beds and crisis centers for children and adolescents.

Medicaid rebase: This removes $350 million (R), 7.8%, from the Medicaid budget based on lower than projected costs for health care and the number of people eligible for Medicaid. These funds were moved into the general fund to support other budget increases.

 

Special provisions of note

The state budget includes policy provisions directing how funds are to be used and often include requirements to look at how departments or programs are operating, including the fiscal impact of making changes to them. A number of provisions could have effects on intellectual and/or developmental disability services.

IDD Study/Study Innovations Waiver: In the budget, the General Assembly’s Joint Legislative Oversight Committee on Medicaid and NC Health Choice is directed to study issues related to the delivery of services for people with I/DD, including causes and solutions for the growing wait list for Innovations home and community-based waiver slots. Potential solutions to address the wait list that are mentioned in the study are funding increases, creating “supports” waiver slots, and utilizing 1915(i) waiver options. The study is also expected to take a look at issues surrounding single-stream funding (state funds for non-Medicaid services), the impact of federal mandates on supports and services, and the coverage of services for autism including any state plan amendments needed to address guidance from the Centers for Medicare and Medicaid Services that directs states to offer autism behavioral services such as Applied Behavior Analysis (ABA) or other treatments.

Rate study for residential services: This would study the “adequacy” of rates paid to providers for residential services, including supportive services such as respite, room and board, Special Assistance, transportation, and state-funded supports.

LME/MCO gap analysis and strategic plan: Section 12F.10.(B) of the budget special provisions requires the NC Department of Health and Human Services to develop a strategic statewide plan to “improve the efficiency and effectiveness of state funded behavioral health services,” including IDD services. Included in this plan are a determination of the state agency responsible for state-funded behavioral health, defining current and future roles of the LME/MCOs; a process for including measurable outcomes in contracts with providers and managed care organizations; a statewide needs assessment for MH, IDD, SUD, and TBI, looking at a continuum of care across services and counties; “solvency standards” for fiscal management of LME/MCOs; and anything else needed for the report. The plan and report to the General Assembly is due January 1, 2018.

Study of Medicaid coverage for school-based health: The General Assembly has asked NC DHHS to identify all school-based health services that are eligible for federal matching funds through Medicaid and report on the fiscal impact of adding Medicaid coverage for these school-based services not currently offered in NC.

Report on the progress of ABLE program trust: The Department of the State Treasurer is required to report to the General Assembly by December 1 on the status of the Achieving a Better Life Experience (ABLE) Trust program that would allow people with disabilities and their families to open 529 savings plans.

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

Speak Out on NC Budget Proposals

gavel31

This article was contributed by Jennifer Mahan, Director of Advocacy and Public Policy at ASNC.

On June 1, the NC Senate released its version of the budget adjustments bill for this year. Despite advocacy directed at the Senate to improve on what the NC House budget offered, the Senate includes no funding for federally required autism behavioral services (EPSDT), child or adult IDD crisis funding, pilot programs for targeted case management, or other autism services. The Senate instead reduces funds to the Medicaid base budget by 8%, rather than investing in needed autism services. The Senate included only $30 million in replacement funds for state-funded services to the Local Management Entities/Managed Care Organizations (LME/MCOs), and that funding is contingent on there being savings elsewhere in the budget to support it. The total loss of funds to LME/MCOs over two years is close to $275 million. In addition, the Senate does not include enough funding to take hundreds of families off of the waiting list for the K-12 students with disabilities scholarship.

Senate and House budget committee members are now starting the conference committee process, in which they will come to agreement on the differences between the two versions of the budget. There is still time to push for conference committee members to take the House budget numbers, which do not include everything we have asked for, but are better for people on the autism spectrum. To view the Senate and previous House budgets go to the General Assembly website.

Why are the Senate budget numbers a problem for children and adults with autism?

  • North Carolina has 12,000 people waiting for Innovations waiver services
  • While they wait, sometimes going into repeated crises, the only services they may qualify for are state-funded through the LME/MCO or in some cases, Medicaid EPSDT autism services. State-funded services administered by the LME/MCOs fund things such as crisis care, respite services, day services, residential care, and social and recreational programs. These programs build skills, provide safety and support, and give families a needed break.
  • During a crisis, they wait in emergency departments for scarce beds in programs that have the capacity to help them.
  • And during all this, they no longer have case management to assist them with system navigation, finding resources, and helping families advocate for better care.
  • Hundreds of children are waiting for K-12 scholarships even though legislators have said they are committed to offering a variety of educational options for students with disabilities who may not be able to be served in the public school system.

What can you do?

The needs of children and adults with autism are many, but there are solutions. North Carolina has the revenue to start making targeted investments in serving those who need services and educational options. Please call or write the NC senators below and ask them to start doing so now.

1) Autism Services: Contact the NC Senators listed below to ask for funding in the Health and Human Services budget for people with autism including Innovations waiver slots, crisis services for those with intellectual and developmental disabilities, and funding for needed autism services in Medicaid.

The message is simple: Too many people with autism are waiting years for help. NC needs to fund Innovations waiver slots, crisis services, and autism services in Medicaid, and return funding to LME/MCOs for people who have no other access to services.

If you have a family member on the autism spectrum, are waiting for help, and/or have been helped by services in some way, share your story.

  • Ralph Hise, Co-Chair Health and Human Services Appropriations, 919-733-3460, Ralph.Hise@ncleg.net
  • Louis Pate, Co-Chair Health and Human Services Appropriations, Deputy President Pro Tem, 919-733-562, Loiuis.Pate@ncleg.net
  • Tommy Tucker, Co-Chair Health and Human Services Appropriations, 919-733-7659, Tommy.Tucker@ncleg.net

 

2) K-12 Scholarships for Students with Disabilities: Contact the NC senators listed below to ask for funding to remove the waiting list for K-12 scholarships for students with disabilities in non-public schools.

The message: Ask the senator(s) to support the House’s budget, which puts $5.8 million in the budget for children and families on the waiting list for K-12 students with disabilities scholarships.

If you are on the waiting list or your family has found success in using the scholarship, please share your story.

 

3) Support the House budget for HHS and Education: Call the following NC House “Big” Appropriations Chairs/Members and tell them to support the House budget numbers during the budget conference committee process.

The message is simple: Use the House position on funding for Medicaid services, LME/MCO funding, crisis services, and the scholarship for students with disabilities.

 

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

Learn About Innovations Waiver Changes, Share Opinions on IDD Issues

Medicaid Diversion

UPDATE: The North Carolina Department of Health and Human Services has notified us that the changes to the Innovations waiver are now proposed to go into effect November 1 to allow for additional training and preparation, and to provide additional time for approval of the changes by the Centers for Medicare & Medicaid Services (CMS).

The North Carolina Department of Health and Human Services (DHHS) and local LME/MCOs will hold a series of listening sessions on the Innovations Waiver and other issues related to intellectual and developmental disabilities (IDD) during the next few months. Staff from the state and local LME/MCOs will also be there to listen to needs, concerns, and thoughts around system reform, issues with health care, services, employment, housing, crisis, or other topics facing individuals, families and others who care about individuals with autism and other IDD.

Staff will also highlight some of the upcoming changes to the Innovations Waiver, set to take place this spring. To read a previous ASNC blog post about the upcoming waiver changes, click here. An overview of the Innovations waiver and updates are found on the Innovations landing page.

 

IDD Innovations Listening Sessions

February 2, 5:30-8 p.m.

Western Carolina University Biltmore Campus

28 Schenck Parkway, Room 346

Asheville, NC 28803

 

February 3, 5:30-8 p.m.

Partners Behavioral Healthcare

1985 Tate Blvd., SE

Hickory, NC 28602

 

February 4, 5:30-8 p.m.

Cardinal Innovations

4855 Milestone Ave.

Kannapolis, NC 28081

 

February 16, 5:30-8 p.m.

Beaufort County Ag Center

155-A Airport Road

Washington, NC 27889

 

February 17, 5:30-8 p.m.

Eastpointe

514 E. Main St.

Beulaville, NC28518

 

February 18, 5:30-8 p.m.

Trillium Health Resources

3809 Shipyard Blvd.

Wilmington, NC 28403

 

March 1, 5:30-8 p.m.

CenterPoint Human Services

4035 University Parkway

Winston Salem, NC 27106

 

March 2, 5:30-8 p.m.

FirstHealth Conference Center

Monroe Auditorium

9305 NC Hwy 211

Pinehurst, NC 28374

 

March 3, 5:30-8 p.m.

Creedmoor Baptist Church

6001 Creedmoor Road

Raleigh, NC 27612

Autism Insurance and Annual Enrollment: Proactive Planning Pays

health_costs

Editor’s note: This article is informational in nature and should not replace a thorough reading of your employer’s benefits literature. Each insurance plan is different, and often employers offer multiple plans.

When enrolling in health care insurance, one must consider many factors:

  • Amount of coverage
  • Out-of-pocket cost
  • Availability of providers (in-network)

If you have a child on the autism spectrum, your medical costs are likely higher, so research and planning are important.

In North Carolina, many employees are in the process of enrolling in their insurance plans. For families that have a child on the autism spectrum – particularly state employees and others who work for a company that provides autism coverage under their health plans – the enrollment period gives you an opportunity to reassess your coverage and to plan for the health care that your family and child with autism need. Often, enrollment also provides an opportunity to set aside funds to cover copays for treatment, therapy, and/or deductibles, as well as reduce your taxable income for 2016.

We will focus on the NC State Health Plan for Teachers and State Employees (SHP) in this blog, as there are more than 85,700 state employees across North Carolina, according to the NC Office of State Human Resources.

If you are a state employee, the autism treatment benefit that went into effect on January 1, 2015, and continues in 2016 creates more opportunities to seek additional treatment or therapy for your child and have it covered through insurance.

  • In 2015, the SHP offered a benefit of up to $36,000.
  • There was no deductible, but copays did apply: $30 per visit if you were on the 80/20 plan and $35 per visit for the 70/30 plan.

When thinking about which insurance plan to choose and how to allocate dollars, here are some things to consider:

Are there providers in my area?

  • Can you find someone to provide autism treatment close to where you live?
  • Are they in-network with SHP?
  • Are the clinicians and behavior technicians licensed and/or certified? Do they have the necessary level of supervision, conducted by an appropriate clinician?
  • Does the provider have a waiting list?
  • If there is no local provider, how far do you have to travel for treatment?

What will the treatment cost?

  • The plan you choose will determine your out-of-pocket expense in co-pays (SHP only).
  • For example purposes, we will assume weekly ABA therapy sessions, with three visits per week to calculate expenses: $30 x 3 x 52 = $4,680 or $35 x 3 x 52 = $5,460.

How can I cover those expenses?

  • The state – and many other employers – allow you to set up a Flexible Spending Account (FSA) for health care (up to $2,250) that can be used to pay providers, or reimburse you, for expenses such as medicines, copays, and deductibles. Money is deducted from your paycheck pre-tax, which lowers your taxable income.
  • Any expenses above your FSA are paid out of pocket and are tax-deductible.
  • Scholarships and grants are available to families who cannot afford out-of-pocket costs associated with necessary health care. For example, United Healthcare offers a grant for children younger than 16 if their families qualify financially. You need not be a member of United Healthcare to apply.

How does an FSA save me money and help my family?

  • If you used an FSA, $2,250 of the annual co-pays is payroll-deducted and not taxed. This does two things to help you: 1) it lowers your annual taxable income by $2,250, and 2) Because the money is taken out pre-tax and your taxable income is lowered, you may end up with more take-home pay.
  • The full amount you elect to have deducted is available immediately, even though you will not have “contributed” all of the total until the end of the year. That means you are getting a “free advance” that can be used to cover medical treatments.

Co-pay amounts are not inexpensive and could be significantly higher depending on the needs of your child. However, compared to paying for ABA completely out of pocket with no insurance, in our examples, state employees pay 13-14% of the total cost of care. That’s worth spending some extra time reviewing your options and selecting the plan under the SHP that’s best for your child’s needs and your family’s situation.

In addition to the SHP, many companies in North Carolina currently provide an autism benefit. Companies offering autism treatment coverage include:

  • Abbott Labs
  • Apple
  • Bank of America
  • Cisco
  • Credit Suisse
  • Deloitte
  • Eli Lilly
  • General Electric
  • Home Depot
  • IBM
  • JP Morgan
  • Liberty Mutual
  • Merck
  • Michelin
  • Microsoft
  • NBCU/Comcast
  • NetApp
  • Nexsen Pruet
  • PricewaterhouseCoopers
  • Qualcomm
  • R.R. Donnelley
  • TD Bank
  • Time Warner Cable
  • United Technologies
  • Wells Fargo
  • Wake Forest Baptist Health System
  • Verizon

If you work for any of the above companies, consult with your HR representative about making your insurance benefits work for you and your child.

Looking Ahead

SB 676 “Autism Health Insurance Coverage” was signed into law by Gov. Pat McCrory on October 15. The implementation date is July 1, 2016. Group insurance plans renew on a quarterly basis, so the new benefit will be added to plans when they renew over the next year starting July 1, 2016. Plans that renew on July 1, 2016, will start then, and plans that renew after July 1 will offer the benefit starting with the renewal date: October 1, 2016; January 1, 2017; and April 1, 2017.

SB 676 provides coverage of up to $40,000 annually, up to 18 years of age. If your employer is based in NC and is a large group employer (50+ employees), check with your HR department to see whether you will be eligible for autism treatment benefits. If your company will begin covering autism treatments, consider your options for maximizing the benefit and reducing your out-of-pocket expenses. Carefully consider your situation and thoroughly review your benefits information so that you are able to provide the best possible options for your child on the autism spectrum.

Health insurance and tax implications are never simple. With planning and research, you will be able to provide the best opportunity for your child and family.

The Autism Society of North Carolina provides Adaptive Behavior Therapies for autism treatment, including Applied Behavioral Analysis (ABA). ASNC offers these services via insurance and private pay in the greater Charlotte and Raleigh areas. If you are interested in learning more, click here to complete an interest form and a member of our clinical team will be in touch.

A Closer Look at North Carolina’s 2015-17 Budget

GA Front

This article was contributed by Jennifer Mahan, Director of Advocacy and Public Policy at ASNC.

The new state budget for budget years 2015-17, which began on July 1, 2015, sits at $21.7 billion. It includes several important policy initiatives for people with disabilities, but it also makes changes that could keep people with autism, intellectual and developmental disabilities, and other conditions from gaining access to health care and supportive services.

Note that where two numbers are listed for funding amounts, the first number is for fiscal year 2015-16 and the second is for fiscal year 2016-17. Recurring funds mean that the program will be funded in an ongoing way (at least for the next two years), and nonrecurring indicates that funds are one-time and only for a particular year.

Medicaid

This year’s budget funded increases in the Medicaid rebase, which is the funding it will take to continue serving the eligible population with current services. No cuts were made to Medicaid eligibility or to optional Medicaid services. This is a big win; previous budgets have included one if not both of these cuts.

In addition, Medicaid reform legislation was taken out of the original budget bill and passed as separate legislation. The changes to North Carolina’s Medicaid health care and disability services program will create a new Medicaid managed care system and change the state agency that operates the Medicaid programs. Medicaid services will be contracted out to private managed care companies and regional provider (hospital) led health systems. ASNC staff are reviewing the final Medicaid bill and will post more information in the future.

The Medicaid rebase was funded at $299,358,485 recurring and $496,326,936 recurring.

Medicaid reform was funded at $5,000,000 recurring and $5,000,000 recurring.

Vocational Rehabilitation

No cuts were made to Vocational Rehabilitation funding. Again, previous budgets have included cuts.

Early Intervention

No cuts were made to early intervention services, and Children’s Developmental Service Agencies (CDSAs) were not consolidated further.

State-Funded Services

Cross Area Service Program (CASP) funding did see an increase of $800,000 recurring in the first year of the budget and $1.6 million recurring in the second year. CASP funds services such as employment and vocational supports for people with IDD.

“Single-stream funding,” which provides some state funds for people without health care (non-Medicaid populations) was removed from the budget, and the General Assembly required LME/MCOs to use their fund balances to make up the difference. Single-stream funding pays for services such as developmental therapies, respite, employment support, residential supports, and other services. This swap removes state funds and replaces them with LME/MCO cash fund balance money for two years at the following amounts: $110,808,752 and $152,850,133. This is a nonrecurring adjustment, and the special provision language sets up the expectation that no service will be reduced or cut. Special provision language also states that the LME/MCO system must use fund reserves to fill the state dollar reductions.

Advocates have several concerns:

  • LME/MCOs have varying fund balances, and at this time, it is not clear what formula will be used to determine where funds are reduced.
  • Fund balances are intended to be used to expand services, so this “swap” that removes recurring state funds and replaces them with onetime LME/MCO funds from savings eliminates the possibility that funds can be used to expand services. The funds instead will be used simply to maintain existing services.
  • House Bill 916, which created the current public managed-care system, promised that savings would be retained and used to expand services to the thousands waiting for help.
  • It’s not clear that there are enough funds to take the *second round of cuts* in 2016-17, leaving the real possibility that services for people with autism and IDD without Medicaid or other health care will continue to shrink. ASNC will be working with other advocacy groups to prevent further cuts and services reductions.

Crisis Services

New NC START funding for crisis prevention and intervention was included in the budget with $1,544,000 in recurring funding to support children and adolescents with intellectual or developmental disabilities for both years of the budget. While this is not enough funding to support the significant need for crisis services, it is a first step for children and youth who have very limited options.

ABLE Act Funds

The NC Office of the Treasurer will oversee the new ABLE Act 529 savings accounts. The budget includes $215,000 in recurring funds and $250,000 in nonrecurring funds for 2015-16, and $540,000 in recurring funds and $55,000 in nonrecurring funds to administer the new savings plans, provide information to financial experts, and promote the plans to people with disabilities and their families. The IRS is expected to publish their final rules on how the plans will operate by the end of 2015, and NC hopes to have the ABLE savings plans available by the summer of 2016.

Education

The budget fully funds teacher assistants, lowers class size for K-3 grades, and fully funds the current exceptional children’s head count. Reading camps have been expanded to include first- and second-grade students who are at risk for not reaching third-grade reading proficiency. The program also will continue to support at-risk students who reach reading proficiency to ensure they stay on track.

No new funds are included to increase per-pupil spending for exceptional children (special education) or to alter the 12.5% cap on special education funds. ASNC continues to discuss with Education Committee members the ways to improve special education and funding.

Significant sections of House Bill 921, Educational Opportunities for People with Disabilities, also were included in the budget in two separate sections on elementary and post-secondary education. Section 8.30.(a) states that North Carolina will study and develop policy changes for improving outcomes for K-12 students with disabilities including ways to:

  • Raise graduation rates
  • Provide more outcomes-based goals
  • Ensure access to career-ready diplomas
  • Integrate accessible digital learning options
  • Provide earlier and improved transition planning

State agencies are expected to reform the IEP process to focus on outcomes-based goals, bring together stakeholders to improve transition services plans, create ways for students with IEPs to access Future Ready Core Courses of Study (technical and vocational education) as a viable alternative to Occupational Course of Study diplomas, and look at model programs for increasing school performance and graduation rates. The NC Department of Public Instruction is required to report to the General Assembly’s Joint legislative Oversight Committee on Education on the above activities by November 15 and annually thereafter.

Section 11.19.(a) requites state agencies to collaborate to support educational opportunities for students and young adults with intellectual and developmental disabilities, particularly in transitioning to adulthood, post-secondary education, and employment. It requires the NC Department of Health and Human Services; the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services; the University of North Carolina system; and the community college system in consultation with the NC Postsecondary Education Alliance and other stakeholders to:

  • Assess system gaps and needs for supporting students/people with disabilities transitioning into adulthood
  • Develop policies and programs to expand post-secondary educational options and employment
  • Implement more public awareness of post-secondary education and employment of people with disabilities
  • Develop joint policies and common data indicators for tracking outcomes of people with disabilities leaving high school
  • Consider options for technology to link agency databases

ASNC advocated for funding to support technical assistance centers to support the above activities, but these were not funded in the budget. We will be going back to the legislature during the short session to continue to work on additional funding.

Students with Disabilities Scholarships

The Students with Disabilities Scholarship for students with IEPs who opt for non-public education was increased from $3,000 to $4,000 per semester ($8,000 per year), and policy changes allow funds to be dispersed to families and schools prior to the school year. Due to increased demand, there is a waiting list for the scholarships. ASNC will continue to advocate for additional funds to serve those waiting.

In addition, House Bill 334, passed at the end of session, will change the re-assessment process for students in receiving the scholarship: students must either be “assessed for continued eligibility” by a) the local Education Authority to determine if the child is still a child with a disability under IDEA, OR b) by a licensed psychologist with a school psychology focus who shall assess whether the non-public school has improved the student’s educational performance and the student would benefit from continuing to attend the non-public school.

Additional Provisions of Interest

Medical Tax Deduction: This budget fully restores the Medical Tax Deduction that existed prior to the Tax Simplification Laws of 2013. Individuals and families who lack insurance coverage or whose autism therapy and related medical costs are not entirely covered by insurance may benefit from this state tax deduction. (See your tax professional for more information about tax deductions.)

Single-Case Agreements: LME/MCOS can contract with out-of-network providers of developmental disability, mental health, or addiction services. This provision allows for a more simplified contracting process for providers outside the catchment area for up to two cases per provider. (Inpatient providers are allowed up to five cases). Advocates hope that the expansion of out-of-network agreements will allow people to move from one LME/MCO catchment areas to another without a break in needed services as well as ensure access to specialty providers in areas where they are limited.

Overnight Respite: A pilot program will expand statewide so that adult day-care and adult day health-care facilities can provide overnight respite under new licensure rules. The new rules should allow overnight respite to be incorporated into Innovations/CAP waiver amendments and will not require additional legislative approval before submission to the federal government for approval.

What’s missing from the budget?

The biggest gaps in the system for people with autism and other intellectual and developmental disabilities were not addressed. There are 12,000 people on waiting lists for services and supports, including Innovations waivers through our LME/MCO system. This budget does not address funding for the 3,000 slots for support waivers that were to be created for those waiting for help. While the Centers for Medicare & Medicaid Services now require states to provide behavioral services to children with autism under Early and Periodic Screening, Diagnostic, and Treatment (EPSDT), no new funds were added to the Medicaid budget to address this need. With LME/MCOs capitation rates remaining the same, it’s not clear how they will pay for an increase in services such as adaptive behavior treatment to address core autism behavior challenges.

Earlier versions of the budget included a proposal for a case-management pilot program, which was not included in the final budget. Case management is critical for people dealing with complex medical, developmental, and disability issues.

As mentioned above, there are no increases in special education funding or plans for alternatives to the 12.5% cap on funding. Students with disabilities who want to access the non-public school scholarships will wait for more funds to be put into the scholarship program.

The legislature is requiring LME/MCOs to swap state funds for their fund balances for two years in a row. This removes savings intended to expand services and could cut services in the second year.

The 2016 short session, which begins at the end of April, is the next opportunity to make adjustments to the state budget. ASNC will continue working with legislators to address gaps in services.

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

Learn More about ASNC with New Podcasts

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Online interviews explore issues faced by the autism community in North Carolina, provide information about the Autism Society of North Carolina’s services and supports, and share personal stories.

If you have a smartphone, you probably use it for more than phone calls. Today’s technology enables us to use our phones to listen to music, watch movies, track our health, play games, and much more. One of the ways that many organizations are sharing information is through podcasts or online audio. The Autism Society of North Carolina (ASNC) recently joined this growing community with a SoundCloud feed.

What does all this mean? If you are over 40 years old, the easy answer might be to ask your kids or a millennial coworker to explain it, as they are likely more plugged in to this medium. But, if you prefer not to go that route, here’s a simple answer: Our feed is like a radio broadcast that can be listened to at your convenience. You can stream it while sitting at the computer or download it and listen during your commute or workout. You can also subscribe to receive notifications when we add new episodes.

We are doing this because now, more than ever, it’s important to have information at your fingertips. Being online with portable media that you can hear and share with other families and friends is important to increasing understanding of autism, the issues that are affecting the NC autism community, and how ASNC helps.

It’s an exciting first step in adding digital content to the web that will help self-advocates, parents, professionals, and the public. This builds on other digital initiatives including the live webinars facilitated by our Autism Resource Specialists. (Click here to see the workshop schedule and look for “webinar” in the title.)

We have plans to add more episodes in the coming year, so please take a few minutes to explore and listen. If you have ideas for topics, please email me at dlaxton@autismsociety-nc.org.

Now, for a brief tutorial on how to access our broadcasts.

  • Option 1: On your computer, smartphone, or tablet device, go to https://soundcloud.com/autismsocietync. From here you can see all the episodes and topics we have uploaded. Click on what you want to listen to and enjoy!
  • Option 2: Download the SoundCloud app for your device from the iTunes or Google Play stores. (It’s a free download.) Create an account and then search for “AutismSocietyNC.” Our stream will appear and you can “follow” us to receive updates and new episodes.
  • Need help? Contact us at info@autismsociety-nc.org.

Thanks for reading. Happy listening!