Governor's Budget Recommendations April 20, 2010

Governor Perdue released her recommended adjustments to the state budget today. The full document is available online. The budget cuts approximately $1 billion from the overall state budget. Just a reminder, this is just the beginning of the budget process - the budget has to go through the Senate and the House, and back to the Governor before all is said and done.



Of particular note for people with disabilities:

• In the Division of Medical Assistance recommendations, there are several proposed changes to the Medicaid program that are predicted to save money by reducing or eliminating services:

Implement independent assessments on high-cost services to ensure proper utilization. Targeted rate reductions and "other measures" may be implemented to achieve necessary savings.

Various changes to optional services to improve utilization management, including reducing the maximum number of visits for adult speech therapy, physical therapy, occupational therapy and respiratory therapy.

Elimination of in-home Personal Care Services for adults and the creation of a new program for adults with the most intense needs.

Changes to private duty nursing (PDN) services, including transitioning adult PDN recipients to a new Community Alternatives Program (CAP) technology waiver. PDN services will continue to be available for children but it is recommended that independent assessments be conducted for children that receive the service.

Changes to mental health services, including modifying Community Support Team services and delaying the implementation of Peer Support from July 1, 2010 to January 1, 2011.

Limit adult dental coverage to emergency care only.

Reduce the number of outpatient mental health service visits for children before approval from 26 to 16.

• There are proposed expansions in the Division of Medical Assistance budget: One regarding adult care homes: "Funds are recommended to develop and implement a 1915(c) Medicaid Assisted Living waiver for individuals that reside in adult care homes that meet skilled nursing level of care and currently receive State County Special Assistance (SCSA). The waiver will allow fora targeted reimbursement based on acuity levels for the personal care services provided in adult care homes." ($9 million appropriation)
• There is also a proposal to allocate $8.5 million to expand NC Health Choice enrollment.
• In the Division of Mental Health, there is estimated savings from the conversion of the Whitaker School to a PRTF ($1.9 million). There are also proposals to provide funding to develop local in-patient bed capacity ($12 million for an additional 50 beds), improve the quality of care in residential facilities through training of staff ($534,795), and to restore $40 million to state funded mh/dd/sa services.
• In the Division of Health Service Regulation, there are several proposals to replace state appropriations with federal receipts (from civil monetary penalties assessed against nursing homes and Medicaid receipts to support licensure and certification activities), to establish fees (for adult care home medication aide and administrator testing), and to make the jails and sections receipt supported ($420/facility and $17.50/bed).
• In the Division of Vocational Rehabilitation, there is a proposal to reduce the Basic Support Case Services program by $2 million on a non-recurring basis; and to reduce the Independent Living program budget and staff by $1.3 million (eliminates 8 recreational therapist positions).
• In the Division of Social Service recommendations, the Governor is proposing a change in the percentage the state pays for Adult Care Home Specialists who monitor and inspect adult care homes. Federal funds pay for 50% - currently the other 50% is split with 40% paid by the state and 10% by the counties; this proposes that the state pay 25% and the counties 25%. An elimination of funding for the school-based Child and Family Teams pilot ($420,804) is also proposed (supported 12 team facilitators) - also eliminated from the Division of Mental Health budget.


• In the Division of Public Health budget recommendations, an additional $3 million is recommended for the AIDS Drug Assistance Program to allow eligible individuals on the waiting list to be enrolled.


• In the Office of Education Services in DHHS, it is proposed to suspend on-site summer school programs ($280,000) and to permanently reduce residential services from 5 to 4 nights at the residential schools ($619,558).


• A $100,000 appropriation to the Special Olympics is proposed.


• In the public schools, state funding to local education agencies (LEAs) is being reduced by $135 million and the amount appropriated for central office administration in LEAs is being reduced by 5%, $5.4 million.


• Funding for Child and Family Support Teams through public education is being reduced by $2.5 million. $9.1 million will remain to support the initiative.


• In the community colleges, $19.8 million will be restored to fund prisoner re-entry education (limited to basic skills and continuing education courses that ensure adequate literacy and job skills to pursue a productive life but curriculum courses and instruction at federal and local facilities will not be offered).


• There is money being allocated on a non-recurring basis to the State Board of Elections to provide matching funds for the Help America Vote Act (HAVA) grant application. This will allow for the maintenance and licensing of voting equipment.
• In the Department of Justice budget, there is a proposal to eliminate the NC Legal Education Assistance Fund program (NC LEAF), which provides loan repayment assistance to legal services attorneys as well as public defenders and district attorneys.
• In the Department of Juvenile Justice and Delinquency Prevention, there is one expansion item: to restore funding for the Samarkand Youth Development Center. It is recommended that the Woodson Wilderness Camp and the Macon County Multi-Purpose Home be eliminated, that the Eckerd Wilderness Camp program be reduced by 155 beds, and that the direct appropriation to the Juvenile Assessment Center be eliminated.
• In the Department of Corrections budget proposals, the Governor has proposed the establishment of operating reserves for the Central Prison Hospital and Mental Health Facility and the NC Correctional Institute for Women Mental Health Facility (both are scheduled for completion in August 2011).

Stay tuned for updates and more details as we move forward!