The NC Senate and House passed the budget conference committee report for H259, the Appropriations Act for 2023-2025 on September 22nd, ending several months of negotiations that delayed the state budget nearly three months into the fiscal year. The budget includes significant amounts of funding for behavioral health and developmental disabilities services and funding for some new programs that specifically support people with I/DD. The passage of the budget also marks the go-ahead for North Carolina to expand Medicaid to lower-income adults who previously fell into the healthcare coverage gap.
Budget highlights
Budget special provisions
Every budget includes policy language that directs how funds in the budget should be used, but sometimes other policy legislation is added to the budget bill as well.
[Abbreviated chart of I/DD items. This does not include all I/DD related items in the budget update]
| Funding Item | Governor | House | Senate | Conference/Final Budget |
| Innovations Waivers
|
$14,205,000 Recurring FY 2023-2024 & $28,410,000 Recurring FY2024-2025
Creates 1,000 new Innovation Waiver slots. DHHS proposes 1,800 slots effective January 1, 2024. |
$6,100,000 Recurring FY2023-2024 and FY2024-2025
This will provide funding for 250 Innovation waiver slots. |
$10,000,000 Recurring FY2023-2024 and FY 2024-2025
This will provide funding for 350 Innovation waiver slots. |
$10,000,000 recurring FY2023-2024 and FY 2024-2025
This will provide funding for 350 Innovation waiver slots. |
| Direct Care Worker Wages-Innovations Waiver
|
$18,000,000 Recurring FY2023-2024 and $72,000,000 FY2024-2025
Invests funds to build on the HCBS rate increase in SL 2021-180. Funding will support a pay increase in each year of the biennium raising the Innovation Waiver Direct Care Workforce wage to $18/hour. |
$60,000,000 Recurring FY2023-2024 and FY2024-2025
Provides funds to increase the wages of direct care workers who provide services for individuals on the State’s Innovations waiver. Pass-through at 85% |
$60,000,000 Recurring FY2023-2024 and FY2024-2025
Provides funds to increase the wages of direct care workers who provide services for individuals. No pass-through language requirement.
|
$60,000,000 Recurring FY2023-2024 and FY2024-2025
Provides funds to increase the wages of direct care workers who provide services for individuals. No pass-through language requirement. There is language regarding providers attesting that this funding will be used to increase wages and/or benefits to direct care workers. While it states in the budget that the intent is to raise hourly wages $6.50 more than they currently are, it is likely that at least another $30 million in funding would be needed to do so. |
| Personal Care Services
|
$30,000,000 Recurring FY2023-2025, FY2024-2025
Increases the Personal Care services rate by $2.14/hour from 2020 levels, making 50% of the COVID-19 rate permanent. (sets rate at $21.34) |
$76,700,000 Recurring FY2023-2024 and FY2024-2025
Increases the Medicaid reimbursement rate for personal care services to $6.25 per 15 minutes, or $25/hour |
No funding in the Senate budget. | $10 million in nonrecurring funding coupled with $50 million in recurring funding for fiscal year 2023-2024 and $60 million in recurring funding for fiscal year 2024-2025 to keep the current COVID-19 rate in place. That rate is $23.84. After several months of extension, this will set a new permanent rate for personal care services under Medicaid Direct, CAP/C, CAP/DA, and CAP/CO. Rates are effective July 1, 2023. |
| Competitive Nonprofit Grants | No Change | No Change | Eliminates funding lines for competitive nonprofit grants. | Restores state funding and federal block grant funds to ASNC and other non-profits as individual state budget line items, not competitive grants. |
| Rates for Behavioral Health Services | $75,000,000 Nonrecurring FY2023-2024 $150,00,000 Nonrecurring FY2024-2025
Invests $75 million in state dollars each year for the next three years to increase rates for inpatient and community behavioral health services, importing access to these services statewide. (IHOPE) |
No specific line item. | $110,000,000 Recurring FY2023-2024 and FY2024-2025
Provides funds to enable the Division of Health Benefits to increase the Medicaid reimbursement rates for behavioral health providers |
$50 million in recurring funding for fiscal year 2023-2024 and $75 million in recurring funding for fiscal year 2024-2025.
This appropriation will enable the Division of Health Benefits to increase the Medicaid reimbursement rates for behavioral health providers. This funding may also be applied to non-Innovation waiver I/DD services. |
| Group Homes Stabilization and Transition | ($10,000,000)
Eliminates the Group Home Stabilization and Transition initiative that was created in 2021. |
($10,000,000)
Eliminates the Group Home Stabilization and Transition initiative that was created in 2021. |
||
| Competitive Integrated Employment | $5,000,000
|
Not in budget | $5,000,000 Recurring for FY2023-2024 and FY2024-2025
Provides funds to support competitive integrated employment through vocational rehabilitation services, day supports, and community services for individuals with intellectual and developmental disabilities. |
$5,000,000 Recurring for FY2023-2024 and FY2024-2025
Provides funds to support competitive integrated employment through vocational rehabilitation services, day supports, and community services for individuals with intellectual and developmental disabilities. |
| Medicaid Rebase | $629,720,781 Recurring FY2023-2024 $913,574,696 Recurring FY2024-2025
Provides funding projected changes in Medicaid enrollment, enrollment mix, capitation costs, and federal match rates, as well as the ongoing transition to managed care. |
$440,000,000 FY2023-2024 and $620,000,000 FY2024-2025 Recurring
Provides funding projected changes in Medicaid enrollment, enrollment mix, capitation costs, and federal match rates, as well as the ongoing transition to managed care. |
$540,000,000 FY2023-2024 and $720,000,000 FY2024-2025 Recurring
Provides funding for projected changes in Medicaid enrollment, enrollment mix, service, and capitation costs, and federal match rates, as well as the ongoing transition to managed care. |
$524,356,886 in fiscal year 2023-2024 and $720 million in fiscal year 2024-2025 to provide the necessary funding for projected changes in Medicaid enrollment, enrollment mix, capitation costs, and federal match rates along with the ongoing transition to managed care.
$650 Million to create a separate fund, Medicaid Contingency Reserve to assist with any Medicaid budget shortfalls. |
| Education Budget | ||||
| Career Pathways Support for Students with Intellectual and Developmental Disabilities
|
Not in budget | Not in budget | $3,963,094 Recurring FY2023-2024 and FY2024-2025
Provides funds to create a regional support network that supports training and job opportunities for students with intellectual disabilities across the State. Funding provided shall be used for college, regional, and State level infrastructures for the program. This includes hiring a program director and technical assistance position at the Community College System Office. |
$3,963,094 Recurring FY2023-2024 and FY2024-2025
Provides funds to create a regional support network that supports training and job opportunities for students with intellectual disabilities across the State. Funding provided shall be used for college, regional and State level infrastructures for the program. This includes hiring a program director and technical assistance position at the Community College System Office.
|
| Vocational Rehabilitation Pilot Program | Not in budget | Not in budget | $750,000 Nonrecurring
Provides funds to the System Office to contract with the Division of Vocational Rehabilitation Services for a 3-year pilot program. The program would place vocational rehabilitation counselors in colleges to assist students with intellectual and developmental disabilities with their career-related goals. |
$750,000 Nonrecurring
Provides funds to the System Office to contract with the Division of Vocational Rehabilitation Services for a 3-year pilot program. The program would place vocational rehabilitation counselors in colleges to assist students with intellectual and developmental disabilities with their career-related goals. |
Creates 1,000 new Innovation Waiver slots. DHHS proposes 1,800 slots effective January 1, 2024.
This will provide funding for 250 Innovation waiver slots.
This will provide funding for 350 Innovation waiver slots.
This will provide funding for 350 Innovation waiver slots.
Invests funds to build on the HCBS rate increase in SL 2021-180. Funding will support a pay increase in each year of the biennium raising the Innovation Waiver Direct Care Workforce wage to $18/hour.
Provides funds to increase the wages of direct care workers who provide services for individuals on the State’s Innovations waiver.
Pass-through at 85%
Provides funds to increase the wages of direct care workers who provide services for individuals.
No pass-through language requirement.
Provides funds to increase the wages of direct care workers who provide services for individuals.
No pass-through language requirement. There is language regarding providers attesting that this funding will be used to increase wages and/or benefits to direct care workers. While it states in the budget that the intent is to raise hourly wages $6.50 more than they currently are, it is likely that at least another $30 million in funding would be needed to do so.
Increases the Personal Care services rate by $2.14/hour from 2020 levels, making 50% of the COVID-19 rate permanent. (sets rate at $21.34)
Increases the Medicaid reimbursement rate for personal care services to $6.25 per 15 minutes, or $25/hour
Invests $75 million in state dollars each year for the next three years to increase rates for inpatient and community behavioral health services, importing access to these services statewide. (IHOPE)
Provides funds to enable the Division of Health Benefits to increase the Medicaid reimbursement rates for behavioral health providers
This appropriation will enable the Division of Health Benefits to increase the Medicaid reimbursement rates for behavioral health providers. This funding may also be applied to non-Innovation waiver I/DD services.
Eliminates the Group Home Stabilization and Transition initiative that was created in 2021.
Eliminates the Group Home Stabilization and Transition initiative that was created in 2021.
Provides funds to support competitive integrated employment through vocational rehabilitation services, day supports, and community services for individuals with intellectual and developmental disabilities.
Provides funds to support competitive integrated employment through vocational rehabilitation services, day supports, and community services for individuals with intellectual and developmental disabilities.
Provides funding projected changes in Medicaid enrollment, enrollment mix, capitation costs, and federal match rates, as well as the ongoing transition to managed care.
Provides funding projected changes in Medicaid enrollment, enrollment mix, capitation costs, and federal match rates, as well as the ongoing transition to managed care.
Provides funding for projected changes in Medicaid enrollment, enrollment mix, service, and capitation costs, and federal match rates, as well as the ongoing transition to managed care.
$650 Million to create a separate fund, Medicaid Contingency Reserve to assist with any Medicaid budget shortfalls.
Provides funds to create a regional support network that supports training and job opportunities for students with intellectual disabilities across the State.
Funding provided shall be used for college, regional, and State level infrastructures for the program. This includes hiring a program director and technical assistance position at the Community College System Office.
Provides funds to create a regional support network that supports training and job opportunities for students with intellectual disabilities across the State.
Funding provided shall be used for college, regional and State level infrastructures for the program. This includes hiring a program director and technical assistance position at the Community College System Office.
Provides funds to the System Office to contract with the Division of Vocational Rehabilitation Services for a 3-year pilot program. The program would place vocational rehabilitation counselors in colleges to assist students with intellectual and developmental disabilities with their career-related goals.
Provides funds to the System Office to contract with the Division of Vocational Rehabilitation Services for a 3-year pilot program. The program would place vocational rehabilitation counselors in colleges to assist students with intellectual and developmental disabilities with their career-related goals.
You can view the state budget by going to the North Carolina General Assembly webpage and clicking on the link to “2023 budget” on the left side of the home page under “News and Information.” “Bill text” is the entire budget document including the special provisions and “Committee Report” is the information on specific funding items in the budget, sometimes referred to as the money report. Please note before printing that budget documents are hundreds of pages long (more than 1400 pages total). You can search the budget .pdf documents by clicking on the image of the round magnifying glass at the top of the document and entering keywords to search the document.
If you have questions about the budget or other public policy issues please contact the Autism Society of North Carolina‘s Jennifer Mahan, Director of Public Policy at jmahan@autismsociety-nc.org.
This content was originally published here.