May 18, 2021
We are five months into the Long Session of the NC General Assembly (NCGA). Usually that means that we have already seen a budget proposal, but not this year. There have been many, many new bills introduced, so many of which could affect our service system in a positive way. There has been an abundance of bills introduced – over 900 in the House and nearly 725 in the Senate. The May 13th crossover deadline, the date by which any bill that does not have funding included must pass at least one of the houses of the NCGA to remain active throughout the remainder of the Long Session 2021 and into the Short Session 2022, has guaranteed a flurry of activity.
What is a little different this session is that we have yet to see a legislative budget proposal. It is expected to originate in the Senate where the shell of budget bills have been introduced in the past. But the publication of the actual budget proposal for the Senate has been slow to make its way from behind closed doors. Don’t mistake this for inaction. Likely there is daily work being done and what the public will see is a budget proposal that has already undergone significant negotiations by legislators to determine spending levels and key components. If negotiations among Senate members have been sufficient, the outward deliberations will likely move quickly through appropriations subcommittees and committees. It’s also hard to know how much success there has been in reaching agreement between the Senate and House prior to the publication of the proposed budget. If there has been agreement, then the NCGA may still be able to pass the budget before the beginning of the next State Fiscal Year on July 1.
There is a strong connection between stand-alone bills and the budget. Often bills that did not meet crossover show up as special provisions in the budget bill. All of this proves that the next few weeks of the legislature will provide us with a good sense how the rest of the Long Session will go.
Here are some of the bills impacting MH/IDD/SUD care moving through the legislature. It is important to note that many of these bills have proponents and opponents.
Closing the Insurance Gap and Increasing Access
Governor Cooper convened a bipartisan group of leaders over the winter to look at options for closing the insurance gap. The most publicized strategy is to expand Medicaid as it is allowed by the federal government. The Governor’s task force members discussed several strategies to close the gap between insured and uninsured individuals. Bills that have been introduced reflect the variety of approaches that are available. They range from full expansion to continuing Medicaid for parents of children in foster care to increasing the venues in which Medicaid services can be provided. Here are some of those bills:
S. 93, Assisting NC Families in Crisis
S. 402, Close the Medicaid Coverage Gap
S. 530, Medicaid for Twelve Months Postpartum
H. 382, Hospital ED Care/Medicaid Behavioral Health Service
H. 470, Medicaid Expansion
H. 809, NC Healthy Family Act
H. 882, Behavioral Health Services for Students
H. 908, Access to Affordable Health Care Coverage for All
Medicaid Transformation, Service Funding and Practice Improvement
It’s no surprise that there continues to be a need for legislative changes to align with Medicaid Transformation and technological advancements. The bills that have been introduced take a variety of tactics to expand service availability—including through telehealth, update licensure rules and prepare for Medicaid managed care through Standard and BH/IDD Tailored Plans.
H. 29, Verification of Immigration Status: SAVE
H. 91, Reduce Regulation to Help Children with Autism
H. 149, Improving Access to Care through Telehealth
H. 383, Medicaid Modernized Hospital Assessments
H. 395, HIE Deadline Extension & Patient Protection
H. 747, Merge NC Health Choice & Medicaid
H. 653, Mental Health and SUD Parity Report
H. 734, Dept. of Health and Human Services Revisions
H. 791, Licensed Counselors Interstate Compact
S. 594, Medicaid Administrative Changes and Technical Corrections – Agency Bill
Consumer-Driven and Peer Support Services
There has been a national consumerism movement that recognizes the positive impact that consumer involvement in their plans of care has on their outcomes of care. Peer Support Services became eligible for separate Medicaid reimbursement in December. These bills are signs of new and encouraging progress at the legislature in the recognition of the value of lived experience in behavioral health and substance use disorders. Several bills have been introduced that will further strengthen North Carolina’s move toward consumer-driven services. An article focused on these new bills was recently published in the Greensboro News and Record. These bills include:
H. 732, the Peer Support Specialist Certification Act will create a formalized process for oversight of the certification
H. 786 provides grant funding to local law enforcement agencies so that they can train and educate law enforcement officers to respond to behavioral health crises.
H. 787 strengthens the data collection on involuntary commitments by requiring certain data be obtained and holding LME/MCOs responsible for aggregating that data for decision making.
H. 788 provides funding for Peer-Run Recovery Wellness Centers and establishes the NC Mental Health Recovery and Resiliency Agenda that will be led by a Mental Health Recovery Policy Chief within the Division of MH/IDD/SUD.
Children, Youth and Family Services
There are a myriad of bills related to social services, juvenile justice, education and MH/IDD/SUD services for children, youth and families. Many advocates are looking at these bills with an eye for cross-system coordination and involvement of families. The Child Well-Being Transformation Council, established to look at the coordination of children’s services, wrapped up their work in August 2020. There are several bills that are a result of their recommendations to strengthen coordination among child-serving agencies. There are also bills that continue to build upon the Raise the Age of the Juvenile Jurisdiction statute that went into effect in December 2019. A number of bills propose increase supports in schools for children experiencing mental health and behavior issues. This is just a sampling of some of the bills that have been introduced:
H. 173, Separate Divisions, Juvenile Justice and Adult Corrections—AB (Agency Bill)
H. 205, Abuse & Neglect Resources in Public Schools
H. 212, Social Services Reform
H. 247, Standards of Student Conduct
H. 249, Children with Disabilities Funding Formula
H. 252/S. 207, Various Raise the Age Changes/JJAC Recs.
H. 516, Raise Dropout Age to 18
H. 579, School Self-Defense Act
H. 615, Juvenile Court Mental Health Assessments
H. 657, School Safety/Threat Assessment Teams
H. 749, Healthy Students – School Psychologists/COVID-19
H. 769, Foster Parents’ Bill of Rights
H. 823, Child Advocacy Centers/Share Information
S. 86, Medicaid Recs/School-Based Health and InCK evaluation/ Child Well-Being Transformation Council Rec
S. 518, Protecting and Supporting NC’s Children
S. 595, Taskforce on Adverse Childhood Experiences
S. 693, Expedite Child Safety and Permanency
Long-Term Services and Supports
Many legislators have expressed support for addressing the long-standing issue of the wait list for individuals with intellectual/developmental disabilities to receive Medicaid services. There are two ways that legislation is approaching this issue. The first is to increase the number of slots available through the Medicaid Innovations Waiver. The second is to increase and stabilize the workforce in I/DD services by raising the pay for direct support staff. The key bills are:
H. 389/S. 350, NC Innovations Waiver Act of 2021
H. 665/S. 610, Address Direct Support Staffing Crisis/Medicaid
H. 914, Support our Direct Care Workforce
S. 615, Direct Care Worker Wage Passthrough/Medicaid