Public Policy Update

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

 

Federal News

American Health Care Act (AHCA) Update

Thank you for calling your US House of Representatives member regarding cuts to Medicaid in the AHCA and the importance of health-care coverage for autism. Your direct advocacy matters! The US House was not able to get enough votes to support the proposed replacement for the Affordable Care Act (ACA). For now, the legislation has been shelved; however, Congress and the Trump administration continue to discuss new proposals around both an ACA replacement and Medicaid funding changes. The Autism Society of North Carolina will continue to monitor federal policy changes. We encourage you to read up on federal proposals; we will be posting occasional updates, alerts, and links to resources about health-care proposals. For more information, read the Kaiser Family Foundation policy analysis comparing AHCA, ACA, and other proposals.

Medicaid is a program that serves millions of people with disabilities and complex health conditions, including people on the autism spectrum. Medicaid Home and Community Based waivers, such as North Carolina’s Innovations and CAP programs, allow people with serious disabilities to live at home with families or in community settings. If you are not already aware of how Medicaid supports people, we urge you to begin reading up on program. ASNC will be posting occasional resources and links to learn more about Medicaid in NC and across the country.

 

Supreme Court Decision about Special Education

The Supreme Court sided with parents who removed their son from school because of an inadequate IEP. In the Court’s ruling, it said that the “appropriate” portion of the “free and appropriate education” guaranteed by IDEA, should be more than just ensuring that children make barely above minimum progress. This appears to indicate legal support for higher standards for IEPs and student advancement: that students with disabilities should be making “meaningful” progress in their education.

What is not clear from the ruling is how schools will help students achieve this progress when IDEA has never been fully funded at the federal level as was promised when the bill passed. Schools are under pressure to serve more special education students with limited resources and a shortage of special education teachers. The Autism Society continues to advocate and the state and federal levels for special-education funding and education programs that address the unique needs of students on the autism spectrum. To learn more, read the National Disability Rights Network statement on the ruling.

 

North Carolina and NC General Assembly News

NC ABLE Update

The NC Department of the State Treasurer has just announced that checking and debit options for NC ABLE accounts are now available. NC ABLE allows people to save money to pay for future or current expenses without losing eligibility for certain government benefit programs.

Signing up for NC ABLE accounts is quick and easy. For more information about how NC ABLE might benefit you or someone you know, see the FAQs.

State Budget

The governor has release his budget proposal outlining priorities for the new administration. The release of this budget also is the start of the legislative budget process for North Carolina. The sovernor’s budget proposal has a number of funding recommendations that could help those on the autism spectrum. Details are below, but include proposals to fund education support, adult guardianship, special assistance, early child development agencies, community-based MH/DD /SA services, complex children’s services, Medicaid services, and Innovations waiver slots.

The NC Senate will start the General Assembly budget process this year by introducing their version of the budget legislation. The General Assembly budget bills are not required to be based on the governor’s proposals. House and Senate leaders are said to be working closely on their proposals, and we expect to see details in the next few weeks.

ACTION: This is a great time to introduce yourself to your state senator and ask North Carolina’s General Assembly to fund much-needed services for autism.

1) If you don’t yet know which state senator represents you, check the second (middle) map on this webpage.

2) Click the link to connect with the district page and find the senator’s email or mailing address. Most are firstname.lastname@ncleg.net, and the address is listed above their email.

3) Write a short, friendly email or handwritten note:

  • Introduce yourself and mention you live and/or work in their district
  • Tell them how you are connected to autism (family, self-advocate, work with, etc.)
  • Ask them, politely, to fund one or more of the governor’s proposals and explain in a sentence or two how that will help someone with autism. For example: “We will be waiting for 7 or more years for services unless Innovations waiver slots are funded.”

This is just one example of what to write; use one that best fits your situation. For more help on advocating, see our tips or our Advocacy 101 toolkit. If you need help figuring out what to say in your email, please contact Jennifer Mahan, our Director of Advocacy and Public Policy, at jmahan@autismsociety-nc.org.

 

Governor’s Budget Proposal Details

Education

  • More School-Based Personnel to Improve Student Outcomes. Establishes a new allotment to be allocated to LEAs based on average daily membership (ADM). Provides $20 million from lottery receipts as flexible funding for LEAs to hire additional school-based personnel who will have a direct impact on improving student outcomes, including assistant principals, nurses, behavioral support staff, teaching assistants, and other instructional support personnel.

Health and Human Services

  • Adult Protective Services/Guardianship. Provides$4.6 million for 2017-18 and 2018-19. Improves the safety of adults who are elderly or disabled and who are subject to abuse, neglect, and exploitation. County Departments of Social Services receive thousands of reports annually and must evaluate and, when needed, provide adult protective services (APS). Additional funding will provide aid to counties to hire social workers needed to reduce APS caseloads and thereby increase quality of service. In addition, there is an increasing need for public legal guardians, who are required when an adult is deemed by the courts to be incapable/incompetent. Funds are provided to increase capacity to provide guardians through local entities.
  • State County Special Assistance. Provides a cash supplement to help low-income, elderly, or disabled individuals remain in their homes or live in licensed adult care homes through the State County Special Assistance program. This program is shared at a 50% participation rate between the state and county. Increased funding is needed to ensure this living assistance benefit is available based upon anticipated enrollment and payments.
  • Invests in Children’s Development Services Agencies. Supports children and families by investing in the Children’s Developmental Services Agencies (CDSA). The 16 regional CDSAs, which serve children who have developmental disabilities and are ages 0-3, require additional staff to comply with federal mandates. Current staff maintain high caseloads that impede their ability to complete evaluations and assessments and initiate services within the required timelines. The request would fund clinical personnel and service coordinators. ($2,541,482R FY17-18 $6,397,430R FY 18-19)

MH/DD/SAS

  • Targeted Reinvestment of Community Services Funding. The base budget increases community services funding by $152.8 million on a recurring basis. Of these funds, $105.8 million in FY 2017-18 and $83.4 million in FY 2018-19 will be allocated to the Local Management Entities/Managed Care Organizations (LEM/MCOs) to meet the service needs of their catchment areas. The remaining balances, $47.0 million in FY 2017-18 and $69.4 million in FY 2018-19, will remain in the community service system, but targeted re-investments to address emerging service needs including those for dually diagnosed children (I/DD and MI), and local in-patient bed capacity. Other targeted investments include support for Innovation waiver slots and housing and supported employment pursuant to the settlement with the US Department of Justice.
  • Disability Rights of North Carolina Settlement – Specialty Treatment and Assessments.

Funds the department’s settlement agreement with Disability Rights NC. The agreement will build system capacity to better serve children with a dual diagnosis of intellectual/ developmentally disabled (I/DD) and behavioral health needs. The request will fund comprehensive assessments and services, to include home health care, rehabilitative and personal care services, and an outpatient clinic at the Murdoch Center. (This is funded through the targeted reinvestment of community services funding in the base budget.)

Medicaid

  • Medicaid Rebase. Provides funds for changes to enrollment, utilization, costs, rates, and services associated with the Medicaid program. This recommendation reflects the amount of change from the base budget to fund the current Medicaid program in the upcoming biennium. This would include funds to address autism behavior services under Early Periodic Screen Diagnosis and Treatment requirements (EPSDT).
  • Expand DD Innovation Waiver Slots. Provides funds for changes to enrollment, utilization, costs, rates, and services associated with the Medicaid program. This recommendation reflects the amount of change from the base budget to fund the current Medicaid program in the upcoming biennium.
  • Extend DD Innovation Waiver Slots to Lower-Acuity Individuals. Fully funds an additional 1,000 NC Innovations waiver slots, effective January 1, 2018, for individuals that do not need the full range or intensity of services offered under the current waiver, but who will benefit from service at their specific level of need. (This is funded through the targeted reinvestment of community services funding in the base budget.)

The Senate and House are coordinating on the development of NC’s two-year budget, set to roll out in the coming weeks.

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.

Share Your Public Policy Priorities

 

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

The Autism Society of North Carolina advocates with policymakers at the General Assembly, state departments and divisions, and LME/MCOs to help create better services and opportunities for people on the autism spectrum. We are developing our public policy targets for the two-year legislative cycle that begins in January 2017.

Please help us by taking this quick survey, which asks you to prioritize potential public policy targets for the next two years:

https://www.surveymonkey.com/r/HYCB3G3

ASNC is committed to working with policymakers to expand access to services and supports, expand access to health care, improve education for children and young adults, expand access to employment, improve services infrastructure, and ensure that people on the spectrum are able to exercise their rights and live in a just world. Given the MANY needs for public policy advocacy across all of these issues and the limited resources with which to advocate, ASNC must focus on a select number of policy issues as we move forward.

Whether you are an individual on the spectrum, a family member, friend, professional, or other person who cares about people with autism, we want to know what you think. You are a person for whom we advocate, so your input into our public policy targets is crucial. And yes, choosing which issues are most important to you among the many important issues is difficult. We recognize that difficulty and appreciate your willingness to help us make the tough choices.  Our final public policy targets will be released in January 2017.

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

2016 Legislative Wrap-Up: Education Budget and Bills

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

Teacher and school staff raises, education programs and supplies: The budget adjustments bill adds $240 million for teacher and school staff raises, plus an additional $10 million in merit-based incentives. This represents an average 4.7% increase in school staff salaries. Additional funds were added for school supplies ($2.5 million R), digital learning programs ($4 million R, 0.7 million NR) and textbooks and digital materials ($10 million NR). Cuts were made to central office administration at the LEA level ($2.5 million R), the NC Department of Public Instruction ($250,000 R), and grants to 17 afterschool providers from the at-risk supplemental funds ($4.7 million).

K-12 Disability Scholarships: Adds $5.8 million (R) to address the waiting list in the scholarship program for kindergarten through high school students with disabilities attending non-public schools. The program provides scholarship grants of up to $4,000 per semester for eligible students. The revised net appropriation for Special Education Scholarships is $10 million. For more information on who qualifies and how to apply for the program go to the website of the NC State Education Authority. A special provision (technical correction bill) in the budget expands the type of students who qualify for the scholarships. A reminder that only students from K-12 with disabilities who leave the public school system or enter the non-public school system in kindergarten or first grade qualify for the scholarships. The new requirements in the budget now categorize eligible groups based on a priority system which also expands eligibility:

1st priority: Eligible students who received a scholarship in the previous semester

2nd Priority: Students who were enrolled in a public school during the previous semester, OR  who received special education or related services though the public schools as a preschool child with a disability the previous semester, OR a child identified as a child with a disability in the public school system before the end of initial enrollment in kindergarten or first grade, OR (new) a child whose parent or legal guardian in on full-time duty status in the armed forces.

3rd/last priority: (new) a child who has been living in the state for at least 6 months.

These changes allow children with disabilities who are in military families (those currently here and those who moved to the state recently) as well as children with disabilities who left the public school system in previous years to attend non-public schools the opportunity to apply for scholarships. Because qualification for the program is complicated, we encourage families who think they may qualify to contact the NC State Education Authority directly. Please note that if applications for scholarships exceed the funds available for the program, children will be put on a waiting list until funding is available.

Student assault on teacher/felony offense, S343: Advocates including ASNC were closely monitoring this bill that would have made any “assault” (not defined in law) on a teacher or school staff a felony offense. There are a number of objections to the law: NC treats 16- and 17-year-olds as adults and charges, tries, and penalizes them in an adult system; assaults that result in injury already are classified as a felony; and for individuals with behavior disorders, such as autism, their disability may be at the core of the behavior problem. Making it a felony would not change behavior or address the issue of managing behavior in school. Disability advocates were able to get children with an IEP exempted in the bill, but many children with disabilities are not identified by schools. The NC Senate passed the bill, but the NC House still had it under review by committees at the end of session, and it did not pass.

Math curriculum changes, H657: This bill, which came very close to passing in the final weeks of the session, would have required changing North Carolina’s public school math curriculum, despite evidence that changes made in the past four years to the math curriculum are improving students’ math testing and college readiness. ASNC and other advocates were concerned that a new curriculum adapted for students in Occupational Course of Study or for those with learning challenges would not be ready in time given the short deadlines for implementation, that changes might require a return to older standards for passing college-ready math courses for OCS students, and that students enrolled in virtual schools would not have access to math courses. Advocates asked that students with disabilities be exempted from the curriculum changes. Conference committees appointed to sort out differences in the House and Senate versions of the bill were not able to meet, and the bill did not pass.

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

2016 Legislative Wrap-Up: The Budget

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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

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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.

Wrapping Up the 2015 Legislative Session

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

The NC General Assembly recently concluded an eight-month legislative session, the longest on record for the past 14 years. During the long session, ASNC continued to advocate for our legislative priorities, including access to high quality services and supports, better education opportunities, and a system that promotes good outcomes. The NC General Assembly passed a number of bills that affect people with autism and their families. A summary is below.

Budget HB 97: ASNC has posted a separate blog post about items in the state budget that affect people with autism, other intellectual and developmental disabilities, and health conditions. The budget includes a number of policy issues as well as additions and cuts to the state’s two year budget. The full budget bill HB 97 and committee reports can be found on the General Assembly website in the left column on the front page.

Autism Insurance SB 676: Senate Bill 676, “Autism Health Insurance Coverage,” passed in the final day of the legislative session. The new law requires large group health plans to provide health-care benefits for the treatment of autism for children and youth through age 18. The new law applies to companies that operate only in North Carolina with more than 50 employees and who do not “self-insure.” Insurance laws can be complicated, and ASNC recommends reading more details in this blog post and checking our autism insurance information page.

ABLE Act for North Carolina: Legislation passed this year will allow people with disabilities and their families to open 529 “ABLE” accounts and set aside money for disability related expenses without losing eligibility for other benefit programs such as Medicaid, Medicare, and Social Security. The law passed this year, and the NC Treasurer’s Office estimates that accounts will be available by summer of 2016. Read more in this blog post. A longer article can be found in our Summer 2015 Spectrum magazine on pages 10 and 11.

Medicaid Reform: NC will create a new Medicaid managed-care system and change the state agency that operates North Carolina’s Medicaid programs. Medicaid services will be contracted out to private managed-care companies and regional provider (hospital) led health systems. The focus of this new system will be on integrating care, especially physical and mental health care, improving health outcomes and controlling costs. All Medicaid services, excluding dental but including those for intellectual and developmental disabilities, are expected to be part of the managed-care model. Changes could take 5-10 years, depending on how long it takes to set up the new system and for the federal government to approve North Carolina’s Medicaid managed-care waiver(s). ASNC staff are reviewing the final Medicaid reform bill and will post more information in the future.

HB 921/Budget Education Provisions: Significant sections of House Bill 921, Educational Opportunities for People with Disabilities, were included in the budget in two sections on elementary and post secondary education. Section 8.30.(a) requires North Carolina to 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 gals, 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.

Changes to 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.

School Staff Assault Bill SB 343: ASNC continues to monitor SB 343 legislation which would make assault on school personnel a felony. Advocates, including ASNC, pushed for changes to the bill that exempted students with IEPs and required assessments to determine if the student has a disability. ASNC remains concerned about the bill given that “assault” is not well defined and many students with a diagnosis of autism or other developmental challenges may not have IEPs. The bill is eligible for consideration in next year’s short session and is currently being held in the House Committee on Children, Youth, and Families.

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.

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

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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.