The 2023 long session at the NC General Assembly is winding down, and the budget is done. Look for more detail in future communications, but here is a session overview of some of the biggest issues:
- Medicaid Expansion
At long last, NC finally is joining the ranks of the states that have expanded Medicaid, a monumental victory for health advocates fighting for those 600,000 people falling in the “coverage gap.” We give special thanks to the NC Department of Health and Human Services (NC DHHS) and the NC General Assembly (NCGA) for their tremendous collaboration and leadership. Expansion rollout will begin on December 1.
- Guardianship Alternatives
Thanks to NCGA support and years of work from advocates involved with Rethinking Guardianship, including many current and former DRNC staff, NC now has a law requiring officials to consider less-restrictive alternatives before resorting to restrictive court-ordered guardianships for people with disabilities. Guardianship is still an option, but only as a last resort; clerks will have more oversight and will ensure that people overseen by guardians are informed of their rights.
The 2023 budget saw very high appropriations for health, especially mental health, including free clinics, rural health facilities, a children’s behavioral health hospital, health workforce development, and support services for families of children with mental health needs.
Among many positive details, the budget:
- Provides for trauma-informed assessments for children in foster care
- Enacts the long-awaited Children and Family Specialty Plan to provide services to families of children in the foster system
- It allows parents to help fill the need for caregiving under the Innovations Waiver
- Increases to $70 a month the Personal Needs Allowance for people living in nursing homes
- Gives NC DHHS more authority to hold LME/MCOs accountable
- Gives Medicaid members more flexibility to switch providers
While these developments are positive, generally we continue to see health care facilities receive the bulk of the appropriations, while home and community-based services, as a whole, are far less generously funded. This is a barrier to making the promise of Olmstead real for the people across NC who want to choose community-based services when clinically appropriate. For example, we were very troubled to see only 350 Innovations Waiver slots added, given the waitlist of over 17,000 people. While $60M was appropriated to increase the pay for Direct Service Professionals, that funding is insufficient to meet the tremendous need and will require continued advocacy to ensure funds actually reach the workers themselves. Mental health funding, likewise, is focused on traditional institutions. NC desperately needs peer-run, community-based housing and treatment options, and other non-coercive and community-based services. With state government experiencing 20-25% vacancy rates, NCGA missed a chance to increase appropriations to staff crucial vacant positions at DHHS and juvenile justice.
- Criminal Legal
The budget included significant funding for diversion and reentry services and for community-based restoration programs, which is critical to the health, well-being, and success of disabled people in the criminal legal system. Also, thanks to years of hard work from many advocates, including DRNC staff and lobbyists, the NC Department of Adult Corrections now must consider medical release for an inmate who is 55 years of age or older, medically incapacitated, and who poses little or no risk to public safety. This is a big win, and an overdue advancement of the rights of people with disabilities in the criminal legal system. Also, the budget includes funding for two jail inspector positions. These positions are desperately needed to help protect the health and safety of disabled people in jails. Missing from the budget, though, were jail safety measures that would have addressed critical problems like overcrowding and other unsafe conditions.
Neither the budget nor key legislation this session advances the goal of making sure students with disabilities get their needs met in the most integrated environment possible. There were some exciting highlights: Additional school psychologists, college training programs for people with intellectual and developmental disabilities (I/DD), and training programs for therapeutic foster families. But overall, the session was disappointing for education. Adequate public school staffing is essential to meet disabled students’ needs, but staff raises were less than one third of what advocates called for (an average 7% increase over the biennium), and do not include reinstating Master’s pay, another incentive important for workforce development. A promising bill to fund specialty schools for children with behavioral health disabilities and I/DD also did not become law. Finally, the dramatic expansion of the Opportunity Scholarship voucher program to all families, regardless of income, creates complex decisions for families. While some children may thrive in the private schools funded with these vouchers, they have fewer rights under federal law in those settings.