Legislative and Advocacy Update

June 11, 2021

This week, leadership in the NC General Assembly reached budget target numbers, debated two bills on rate increase for direct care workers and the Senate passed a major tax bill. On the federal side, advocacy efforts continue to focus on President Biden’s infrastructure plan. The original proposal included $400 billion for home and community-based supports that do not appear to be included in the most recent Senate bi-partisan infrastructure proposal. Multiple national associations continue to work on this critical funding increase. Let’s all get caught up!


In This Issue:

       NC Legislative Update: Provider Relief Fund Payments
       NC Medicaid Managed Care Update
       I/DD,MH, SAS Update: Staffing Stability Survey
       NC Medicaid Bulletins 
       COVID-19 Update
       NC News You Can Use
       National News You Can Use



The House and Senate leadership announced last week an agreement on the spending targets for the state’s budget. The budget target for fiscal year 2021-2022 is $25.72 billion an increase of 3.45%. Fiscal year 2022-2023 will see a 3.65% increase with a spending target of $26.7 billion. Currently, North Carolina does not have a two-year enacted budget. H966, the budget act of 2019, was vetoed by Governor Cooper which was not overturned. North Carolina does have a statue that permit our state to stay open if the state budget remains balanced, we call this a standing continuing resolution. The big remaining question is when do we get to see one of the chambers budget proposal? The Senate goes first this year, and we are hearing that they may roll out their budget within the next two weeks. Our state’s fiscal year starts on July 1, but we do not expect to see a completed budget before the end of July. 


Governor Cooper has stated that the spending targets proposed by legislative leadership falls short of what the State needs. His office further stated that real negotiations need to occur, and they look forward to reaching an agreement. 


We do not expect to see Medicaid expansion in the budget, but we do expect to see tax cuts.


Now let’s look at some bills of interest!


The NC House Health Committee passed the following bills out of committee. These bills do have bi-partisan support.


      HB 665 – Address Direct Sup. Staffing Crisis/Medicaid – The legislation would provide funds to increase the Medicaid per member per month capitation rate paid to local management entities/managed care organizations (LME/MCOs) to include amounts sufficient to increase wages paid to direct support personnel working in intermediate care facilities for individuals with intellectual disabilities (ICF/IIDs) to align those wages with the current wages paid to State employees in State-owned developmental centers.

This legislation appropriates $17, 500,000 in funds for fiscal year 2021-2022 to draw. For fiscal year 2022-2023 this bill would appropriate $21,800,000 in state funding to draw down appropriate matching funds from federal Medicaid.

During committee discussion, Rep. Donna White (R-Johnston) noted that the current turnover rate is above 50% (highest ever) and that it costs approximately $4,000 to train new employees. 


      HB 914 – Support Our Direct Care Workforce – If enacted, the legislation would provide funds for increases in the rates paid to certain Medicaid providers through fee-for-service and through capitation rates paid to prepaid health plans (PHPs) and local management entities/managed care organizations (LME/MCOs). Providers receiving the rate increases would have to use at least 80% of the rate increase to increase wages paid to direct care employees. The rate increases would apply to providers of personal care services (PCS) or home health services, providers of direct care waiver services, and providers of direct care services in the following settings: intermediate care facilities for individuals with intellectual disabilities (ICF/IID), nursing homes, and behavioral health residential facilities. This legislation includes a $160,000,000 appropriation for recurring funding in both fiscal year 2021-2022 and 2022-2023.


And now for that tax bill.


House Bill 334 JOBS Grants and Tax Relief this week. Eight Senate Democrats joined all Republicans in passing this legislation. If enacted, the legislation would reduce the individual state income tax rate, increase the state tax deduction for children, phase-out state corporate income taxes by 2028 and provide grants to businesses affected by pandemic-related shutdowns. In addition, $1-billion would be transferred from the state’s general fund to the “Rainy Day” Fund. The bill has been sent to the House for a concurrence vote.



Tailored Plan Eligible Who Enrolled in PHP Option Update:

As we move forward with preparations to launch NC Medicaid Managed Care on July 1, 2021, the well-being of beneficiaries continues to be the top priority of NCDHHS.   


During the Open Enrollment period, the Department closely monitored data indicating the active selections of Tailored Plan-eligible beneficiaries into Standard Plans. None of these beneficiaries were auto-enrolled in a Standard Plan. Toward the end of Open Enrollment, there was an increased uptick in the number of Tailored Plan-eligible beneficiaries who enrolled in a Standard Plan.   


Through June 1, approximately 7,000 Tailored Plan-eligible beneficiaries made an active selection to enroll in Standard Plans, which may make them ineligible for services they are currently receiving, have recently received, or may benefit from receiving.   


Based on the number and profile of Tailored Plan-eligible beneficiaries who enrolled in a Standard Plan, the Department determined that these beneficiaries would benefit from receiving additional information to ensure they are fully aware of the impact of the decision to leave NC Medicaid Direct and their LME-MCO and enroll in a Standard Plan -- including the potential loss of services.  


Therefore, the Department will stop Standard Plan enrollments of these beneficiaries and all Tailored Plan-eligible beneficiaries who selected a Standard Plan will remain in NC Medicaid Direct and their LME-MCO through NC Medicaid Managed Care Go-Live on July 1, 2021.   


The Department will provide additional information to ensure that these beneficiaries are fully aware of services that may be lost if they move to a Standard Plan. This will include a notice to be sent later this month informing them of the change back to NC Medicaid Direct as well as a detailed list of services that are not available in a Standard Plan.  


Beneficiary choice remains paramount and Tailored Plan-eligible beneficiaries will still have the option to enroll in a Standard Plan. The Department plans to implement, by early August, a specific enrollment process for Tailored Plan-eligible individuals that will include enhanced choice counseling to help verify that beneficiaries have all the information they need to understand the impact of their decisions.   


We will continue to provide updates on this process and appreciate your ongoing partnership in serving the state’s Medicaid beneficiaries and their families.   



Staffing Stability Survey Deadline

We are in the middle of completion of the annual Staff Stability Survey. It is important that as many providers as possible complete this survey to ensure accurate workforce information is received for NC. Many bills are being submitted to NC legislature surrounding our direct support workforce as we look at staff stability and information from this survey will provide an abundance of data about direct support professionals in our state. The completion rate for this survey last year was 34%. Our goal is to have as close to 100% participation from providers as possible. In order do to so, would you please share this flyer with the appropriate person at your agency to ensure your information is included? 


If the contact at your agency has not received information about the survey, please contact and include the name of your agency as well as the contact email. Please note that only 1 person per agency can complete the survey and the same person cannot complete the survey for multiple agencies. Additional questions about the survey can also be sent to the same email address. 


The end date for survey completion is June 30, 2021. 


Please let us know if you have any questions. 


Jen Kelly 

I/DD Consultant 

Division of Mental Health, Developmental Disabilities, Substance Abuse Services 

NC Department of Health and Human Services 





Electronic Visit Verification Implementation Update: Beginning of EVV Claim Adjudication, Alt EVV and Other Topics WEDNESDAY, JUNE 9, 2021. This Bulletin contains updates on the implementation of electronic visit verification (EVV) claims adjudication, entering manual visits, alternate EVV solutions, EVV system updates, EVV implementation for Innovations and TBI Waivers administered by LME-MCOs, EVV implementation for managed care health plans, and quick help tips and resources. More


Billing Code Update for Nurse Practitioners and Physician Assistants

TUESDAY, JUNE 8, 2021. The following procedure code list has been updated recently to include additional nurse practitioner and physician assistant taxonomies. More



Governor Cooper shared an exciting announcement to motivate those who have not yet been vaccinated — and thank those who have! As part of North Carolina’s effort to bring summer back with safe, effective and free COVID-19 vaccines, North Carolina is launching the Your Shot At a Million Summer Cash Drawings. Four vaccinated North Carolinians 18 and older will win $1 million each and four North Carolinians ages 12 to 17 will win $125,000 for post-secondary education. 


As a trusted messenger, we hope you will help get the word out.    

·                  Visit for details about the program. 

·                  Download the Communications Toolkit for resources to promote both drawings 


The drawings are part of the state’s Bringing Summer Back get-out-the-vaccine campaign to increase awareness of the availability and safety of COVID-19 vaccines and encourage North Carolinians to get a COVID-19 vaccination as soon as they can. The vaccines have been thoroughly tested and found to be safe and effective for anyone 12 and older. 


North Carolinians 18 and over who have received at least one dose of a COVID-19 vaccine will be automatically entered into four drawings for a chance to win a $1 million cash prize. Youth between the ages of 12 and 17 who have received at least one dose of the COVID-19 vaccine will be automatically entered into four drawings to win $125,000 towards post-secondary education. The $125,000 can be used at any post-secondary institution and are awarded by funding a savings account in the NC 529 Plan. 


The $4 Million Summer Cash and Cash 4 College Drawings will run from June 21 through Aug. 4. All North Carolina residents 12 and older who have been vaccinated with at least one dose are eligible, some restrictions may apply.  


Those vaccinated starting today, June 10, will be entered twice for each drawing increasing the chance of winning for the newly vaccinated.  


Drawings will take place every other week on Wednesdays with the first drawing on June 23. New entries will close at midnight on the Sunday prior to the Wednesday drawing at midnight. Winners will be verified and then announced.  


Let’s continue to get more people vaccinated through North Carolina—and share this information widely with your networks. 






Budget Agreement 


The North Carolina state legislature’s first budget battle is over: The House and Senate have agreed on how much they want state government to spend. It is $25.72 billion for 2021-22 and $26.7 billion for 2022-23. The decision followed months of negotiations and warnings in the past week that each Republican-led chamber would move ahead without agreement from the other. This is just round one, but an important one. Now the General Assembly is on track to send a budget to Gov. Roy Cooper by the end of July.

In a joint announcement Tuesday morning, Senate leader Phil Berger and House Speaker Tim Moore said that general-fund spending for the upcoming fiscal year would be increased by 3.45%, followed by a 3.65% increase the following year. “This agreement builds on the last decade of responsible Republican-led budgets resulting in a boom decade that put North Carolina on a strong trajectory to recover from the recession,” Moore and Berger said in their joint statement.

The budget agreement, as it stands now, does not include the amount of raises for teachers and other state employees. Nor does it include details on taxes, but the chambers did agree on wanting tax reductions. Lawmakers agreed to spend money on unnamed construction projects, but not to borrow money for a bond. “The agreement dedicates at least $4.2 billion in new capital spending funded through the State Capital and Infrastructure Fund to support critical needs across the state, including several transformational projects,” Berger and Moore said in their statement.

House Appropriations Chair Jason Saine, R-Lincoln, told The News & Observer on Monday evening that with all the federal money coming to the state, they did not see a need for a bond. Budget writers also decided the budget would not include Medicaid expansion, Moore and Berger said. The latest projections from the legislature’s Fiscal Research Division estimate revenues of $27.4 billion next year, they said. They said the $25.7 billion in spending doesn’t include debt service payments. Those will come from the State Capital and Infrastructure Fund, they said.

The governor’s office indicated Tuesday this first round isn’t enough. “Legislative leadership is well aware that this opening announcement falls far short of what our state needs,” Cooper spokesperson Ford Porter said in an email to The N&O. “Real negotiations must occur and the Governor looks forward to working toward an agreement,” Porter said.

One thing state employees can count on, if a budget becomes law, is raises. “There’s raises, I can tell you that,” Saine said, adding that there is not a concrete amount yet. With only a total spending number reached, the amount of raises in the budget is still to be determined. It was at the center of the 2019 budget battle between Cooper and the legislature, along with Medicaid expansion and taxes.

Cooper’s budget proposal calls for an average pay raise of 10% over two years for teachers and administrators, as well as restoring master’s degree pay. He also wants 7.5% raises for school districts’ central office staff and noncertified public school employees over two years. Cooper’s proposal also calls for a $15-an-hour minimum wage for noncertified, public school employees including teaching assistants, cafeteria workers and bus drivers. And he wants to give $2,000 bonuses to teachers, principals, noncertified public school employees, university employees and community college employees the first year, followed by another $1,000 bonus the year after. Cooper’s budget proposal also includes a 7.5% raise over two years for UNC and state-funded local community college employees, and 5% for other state employees. Retired state employee retirees would get cost-of-living adjustment raises of 2% each of the next two years under Cooper’s plan. [Source]



Healthcare Salaries 


The House Health Committee approved two bills Tuesday that would increase funding for some medical workers. House Bill 665 aims to provide funds to address staffing needs for intermediate care facilities, and House Bill 914 would provide a Medicaid increase targeted at direct work staff. Both bills are meant to combat high vacancy and turnover rates at these medical facilities. 

Rep. Donna White, R-Johnston, introduced HB 665 that would provide funding from the state budget to help address staffing needs at intermediate care facilities for people with intellectual disabilities. White said the vacancy rate in these facilities is currently between 16% and 34%, and that the turnover rate is 54%. HB 665 gives $17.5 million in the 2021-2022 fiscal year and $21.8 million in 2022-2023 to the Division of Health Benefits to adjust the rates facilities are paid. The bill recommends that the division adjust rates for cost-of-living and wages.

White added that the direct service providers made an hourly wage of $10.50 prior to the pandemic. White said with other companies raising their wages to $17 and $18 an hour during the pandemic, the direct services providers have lost employees. Lawmakers also heard from three people who spoke about the bill, including Lori Urland, the CEO of Skill Creations, a human services agency in Goldsboro. “We’re finding that we are having a lot of difficulty of having people come work for us,” Urland said, adding that the problem began before COVID-19 but has grown since. “My job vacancy rate is approximately 25%.”

Urland said she previously enjoyed low vacancy rates and staff who stayed with the company for a long time, allowing them to develop relationships with the people they serve. She said various funding sources during COVID-19 have allowed her to raise rates but that won’t last. “We need to be able to continue this as we go forward because if we have to drop back down to $10.50 an hour for employees is going to be demoralizing to them,” Urland said. 

The committee unanimously passed the bill but first debated whether the matter should wait on the budget. “We thought it would be good to get this bill passed through the Health Committee and then as we start the budget process we would incorporate that in the budget plans for DHHS,” said Rep. Donny Lambeth, R-Forsyth.

The second bill, House Bill 914, would provide a Medicaid rate increase to help direct care work staff. The rate increase would go to Medicaid waiver programs including the Community Alternatives Program for Children, the Community Alternatives Program for Disabled Adults, the North Carolina Innovations Waiver, The Traumatic Brain Injury Waiver, personal care services providers, intermediate care facilities for people with intellectual disabilities, home health providers, nursing homes, behavior health residential facilities, Level III and Level IV residential treatment facilities, psychiatric residential treatment facilities, medical management and crisis stabilization facilities and inpatient substance use disorder treatment facilities. 

Rep. Tim Moffitt, R-Henderson, introduced the bill to the committee Tuesday and said his own brother has a direct care provider, but 60 days a year he cares for his brother night and day. Moffitt said through this he learned how hard they work and how problematic their pay has become. “And candidly, I’ve never really thought about the compensation part until it was brought to my attention because we started having vacancies ... and when you started digging into that and you find out what the wages that are paid for these direct care workers is embarrassing,” Moffitt said. “Honestly, I’m embarrassed.” Several people came forward urging lawmakers to approve HB 914 as well. It passed unanimously.


Vaccine Incentives 


Gov. Roy Cooper is expected to announce Thursday a new cash drawing incentive in an effort to get more people vaccinated against coronavirus, WRAL News has learned. The program would be modeled after drawings in Ohio and several other states, a source close to the governor said. Anyone already vaccinated would be eligible, but details are still being worked out as to whether people would have to opt in or the state would use the statewide vaccination database to pick winners.

North Carolina has fallen behind the national pace of vaccinations, and that gap has grown wider in recent weeks. Only 54 percent of adults in the state have gotten at least one dose of the vaccine, compared with nearly 64 percent nationwide, according to state Department of Health and Human Services data.

DHHS recently launched an experimental vaccination incentive program, offering $25 cash cards to people getting shots in four counties. Mecklenburg County was one of the counties participating, and Health Director Gibbie Harris said the program “has proven to be fairly effective, probably even more so that we thought.”

Stacy Wood, a marketing professor at North Carolina State University, co-authored a JAMA Network article about motivating people to get vaccines. Those who are apathetic about getting the shot can be moved by incentives, she said. “It might be a lottery. It might be a free doughnut,” Wood said. [Source]



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