i2i Center is closely tracking legislative areas that will impact behavioral
health, I-DD, and progress towards integrated health. The Governor has unveiled his budget proposal
for the biennium of State Fiscal Year (SFY) 2019-2020 and SFY2020-2021. This signals the formal beginning of the
budget process. It will be up to
legislators as to how much of the Governor’s proposals are included in the
budget that the General Assembly passes for the upcoming biennium.
Close the Insurance Gap
- Provides access to affordable health
insurance to 500,000 North Carolinians the first year—ultimately adding
approximately 626,000 individuals to Medicaid.
It is stated in the Governor’s budget that Medicaid expansion requires
no State dollars, as the federal government pays 90% of the costs and the rest
is paid by hospitals and health plans, including the State appropriations of
$3.3 million recurring for SFY19-20 and $74.9 million recurring for SFY20-21.
- Provides funds to help ensure financial
stability for NC hospitals during the transition of Medicaid to a managed care
system. $22 million non-recurring in
SFY19-20 and $54 million non-recurring in SFY20-21.
- The Governor proposes an aggressive
outreach to North Carolinians who are Medicaid eligible but not yet enrolled to
ensure that many more North Carolinians have health insurance. Projected increases are based on the
experiences of other states and are supported by research-based health policy
simulators. State appropriations
required are $15.7 million for SFY19-20 and $34 million for SFY20-21.
Progress on Medicaid Transformation
- Transform Medicaid and Health Choice from
fee-for-service to managed care by leveraging $268M of the Medicaid
Transformation Reserve and leaving a minimum balance of $132 million in the
Reserve at the end of the biennium:
- Appropriates $107 million from the
Medicaid Transformation Reserve in the General Fund to the Medicaid
Transformation Fund for qualifying needs directly related to Medicaid
Transformation. These funds will support the enrollment broker and ombudsman
program, an Electronic Data Interchange and Information Exchange Portal,
centralized provider data management and credential verification, and finance
and program integrity capabilities. Funds may be used to establish time-limited
positions to support these efforts.
- Appropriates $161.6 million from the
Medicaid Transformation Reserve in the General Fund to the Medicaid
Transformation Fund for the State share of up to $509.1M in total requirements
for qualifying needs directly related to the payment of claims incurred under
the fee-for-service model. When NC transitions to managed care, there will be a
window where the State must finish paying the remaining fee-for-service claims
that were incurred prior to the managed care launch.
Increase Long-Term Services and
- The proposal includes $1 million recurring
in SFY19-20 and $3.2 million recurring in SFY20-21 is appropriated for the
State share to provide additional low-acuity Innovations Waiver slots for
individuals with developmental disabilities who are on the Innovations Waiver
waiting list. According to the
Governor’s budget, 82% of the children and adults on the waiting list are
receiving Medicaid. The Innovations Waiver allows individuals with disabilities
to obtain individualized services and remain in their homes and communities.
These additional slots will become available January 2020.
- It increases funding for the Transition to
Community Living Initiative by $692,000 recurring in each year of the biennium,
which supports eligible adults with mental illness in transitioning from
institutional settings to housing in the community. This funding will provide
additional tenancy and peer support services related to the US DOJ Olmstead
- The Governor proposes that funds be
designated to replace expiring federal receipts for Money Follows the Person to
continue support for transitioning individuals with disabilities from inpatient
facilities to qualified community settings. This funding shifts seven existing
full-time employees (FTE) from receipt-supported positions and adds two new
FTEs to provide administration, management, fiscal oversight, technical
assistance, and direct support to beneficiaries.
Address Opioids, Substance Abuse
Disorders and Mental Illness
- Within the Division of Health Benefits,
the budget proposal includes $5.1 million recurring in SFY19-20 and $6.8
million recurring in SFY20-21 in State share to expand the continuum of
Medicaid services for individuals fighting opioid and other substance use
disorders. Additional services may include substance use disorder halfway house
services and high-intensity residential services for individuals no longer
needing inpatient care but not yet ready to return home.
- The budget proposal establishes eight FTE
(four program managers and four program consultants) within the Division of
MH/IDD/SAS to improve substance abuse treatment and recovery services,
including oversight and monitoring of opioid treatment programs and
administering the Substance Abuse Prevention and Treatment Block Grant, the
Opioid STR Grant, and the State Opioid Response Grant. These positions will be
supported entirely by $802,000 recurring for each year from the Substance Abuse
Prevention and Treatment Block Grant.
- It also establishes three FTE within the
Division of MH/IDD/SAS to improve the quality of mental health services. These
positions will be supported entirely by $133,737 recurring in SFY19-20 and
$267,473 recurring in SFY20-21 from the Community Mental Health Services Block
- Creates 60 FTE positions for Broughton
Hospital, appropriating $8.8 million recurring in the second year of the
biennium, to serve additional patients and provides operational support,
including utilities, maintenance costs, and other physical plant operation
costs in the new Broughton hospital.
- Provides $283,704 for each of the fiscal
years to the Department of Public Safety for three Judicial Management and
Accountability Courts (treatment courts) which provide intensive, specialized
services to defendants with substance use and mental health disorders. The
Governor states that these programs are proven effective in reducing recidivism
and improving health and criminal justice outcomes.
- Provides $5 million non-recurring for
SFY19-20 to expand TROSA into the Triad area to provide substance use disorder
treatment, counseling and help participants learn work skills and find
Offer Affordable Housing
- The proposal increases the annual
appropriation for the Housing Trust Fund to $10 million (increases it by $2.34
million recurring for both years). The
Fund is the State’s most flexible source of money for affordable housing and
allows intensive targeting of vulnerable groups, including people who are homeless
or have disabilities. The Housing Trust
Fund is within the NC Housing Finance Agency budget.
- An additional $20 million in non-recurring
funds is designated for the Workforce Housing Loan Program to develop more safe
and affordable housing units for low and moderate-income citizens.
Increase Employment Opportunities for
Individuals with Disabilities
- Provides state matching funds ($513,000 in
State appropriation for each year) within the Division of Vocational
Rehabilitation to support jobs and training for individuals with disabilities
through the Basic Support Vocational Rehabilitation grant. This will allow
North Carolina to leverage an additional $1.9 million in federal funds.
- Provides $92,400 for each year leveraged
with anticipated receipts to support five Benefits Counselors for individuals
who are blind and/or have other disabilities to support their employment
efforts and explain available support services.
Support for Children and Families
- Invests $15.9 million of lottery receipts
to address the barriers communities face to expanding NC Pre-K, including
rising operating costs and a reimbursement rate that has not changed since
2012. Also increases the NC Pre-K reimbursement rate by 8% per slot and the
administrative support by 2% to build local capacity to expand the number of
eligible children served in Pre-K slots created by SL 2018-2 and maintain
- Increases the State’s investment in Smart
Start by $15 million recurring and $5 million non-recurring for SFY19-20 only
to expand evidence-based, family strengthening and home visiting programs as
well as other early childhood initiatives
- A $14.5 million non-recurring allocation
provides approximately 2,300 additional slots for child care subsidy payments
for children from low-income working families. Child care subsidy allows these
children to receive high-quality child care that supports their healthy
development while parents go to work, search for employment, or receive job
- Adds $1.1M to fund 11 DHHS Child Welfare
positions to improve child welfare training, continuous quality improvement
through onsite technical assistance to counties, and accountability for better
outcomes for children and families. This request also includes $750,000 to
purchase web-based child welfare training for state and county use.
- Increases by $2.9 million recurring
funding within the Division of Social Services for evidence-based intensive
family preservation services to prevent the unnecessary removal of children
from families by improving family functionality, resiliency, and safety.
Raise the Age of Juvenile
- The Department of Public Safety is
allocated $28 million in FY19-20 and $36 million in FY20-21 to increase staff,
court services, facilities, and transportation, and establish focused
programming for the 16- and 17-year-olds who will enter the juvenile justice
system. The proposal also provides $1.2 million in the first year of the
biennium and $1.6 million in the second year for the court system to handle the
increased juvenile caseload.
- Several items within the Governor’s budget
will designate funding to increase staff capacity for expected increase in
caseload when the “Raise the Age” goes into effect on December 1, 2019.
Focus on Healthier Families
- The Governor wants to establish the Office
of Healthy Opportunities to assist DHHS in improving the health and well-being
of North Carolinians, while reducing costs, by impacting both the medical and
nonmedical drivers of health through an innovative, well-coordinated system of
care. These efforts will address the conditions in which people live that
impact up to 80 percent of a person’s health, such as food insecurity, housing
instability, transportation needs, and interpersonal violence.
- The proposal provides $1 million in
non-recurring funds for SFY19-20 for grants to local Food Banks.
Improve Education and School-Based
- The proposal adds flexible funding of $40
million recurring for both years to hire more nurses, counselors,
psychologists, social workers, and school resource officers. Each school will receive at least one
full-time position or the equivalent dollars.
The overall appropriations is expected to fund approximately 500
- $210 million in FY 2019-20 and $390
million in FY 2020-21 is proposed to be invested in teacher and administrator
compensation to reach the highest average salary in the Southeast by 2023 and
to pay principals based on experience and school size. Average pay for existing
teachers increases by 9.1% over the biennium. Funds are also provided to restore
Master’s Pay and eliminate the requirement to pay for a substitute when using
- The Governor proposes an “Invest NC Bond”
that places a $3.9 billion General Obligation Bond, $2 billion of that is
designated for public schools, on the November 2020 ballot to ask voters to
address key infrastructure needs across the State.