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SB 246

Create 13,000 Jobs Serving People With I/DD.

2025-2026 Session Introduced by Gale Adcock and 5 co-sponsors

Expands NC Innovations Waiver by adding 10,000 slots over 2 years with state funding and federal match to cut I/DD waitlists and generate about 13,000 local jobs.

Passed 1st Reading
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Bill Summary · SB 246

SB 246 — “Create 13,000 Jobs Serving People With I/DD”

Status: Passed 1st Reading. Introduced: Jan 30, 2025.

Main purpose

Expand access to North Carolina’s Innovations (Medicaid) Waiver for people with intellectual and/or developmental disabilities (I/DD) by adding waiver slots and state funding so more individuals on the waiting list can receive community-based supports. The bill is framed also as an economic development measure: researchers estimate each new waiver slot generates ~1.3 local jobs, so the bill’s slot increase would create roughly 13,000 direct and induced jobs.

Key provisions

  • Appropriations (recurring General Fund):

    • FY 2025–26: $134,000,000 (state share)
    • FY 2026–27: $357,340,000 (state share)
    • These state amounts are intended to draw federal Medicaid match:
    • FY 2025–26 federal match: $244,750,000
    • FY 2026–27 federal match: $652,660,000
    • Federal funds appropriated to DHB for implementation.

  • Waiver slot increases:

    • FY 2025–26: Add 5,000 Innovations Waiver slots (to be made available Oct 1, 2025, unless delayed by CMS approval).
    • FY 2026–27: Add 5,000 additional slots (to be made available July 1, 2026).
    • All slots to be filled on a first‑come, first‑served basis according to length of time on the Innovations waiting list.

  • Allocation and acceptance procedure (first tranche):

    • DHB will distribute slots using the existing allocation formula (as of the bill’s effective date).
    • Each LME/MCO has 30 days to accept some, all, or none of the slots offered.
    • Any rejected slots are redistributed equally among LME/MCOs that certify:
    • Rates paid to providers are sufficient to pay direct‑care employees at least $20/hour (the LME/MCO may reflect legislatively designated wage supplements in rates); and
    • They have the ability/capacity to provide services in their catchment area.
    • An LME/MCO’s election to accept/reject slots in 2025–26 does not affect distribution of 2026–27 slots.

  • Implementation and oversight:

    • The Department of Health and Human Services, Division of Health Benefits (DHB) is responsible for waiver amendments, distribution, and claiming federal match.
    • All actions subject to any required CMS approvals.

Who is affected

  • Primary: Individuals with I/DD on the Innovations Waiver waiting list (≈19,000 at time of drafting).
  • Service system: LME/MCOs, community providers, direct support workforce.
  • Workforce: Direct care workers (explicit $20/hour wage floor requirement for accepting redistributed slots).
  • State Medicaid administration (DHB) — responsible for implementation and CMS coordination.
  • Employers/local economies — expected job creation and economic activity in local communities.

Timeline & procedural notes

  • Effective date: provisions take effect July 1, 2025 (waiver slot availability dates as above).
  • Slot availability in Oct 2025 may be conditioned on obtaining CMS approval for waiver amendment and the slot acceptance/redistribution procedure.
  • DHB must use current allocation methodology unless CMS disallows the proposed acceptance/rejection redistribution approach.

Fiscal and program impact — summary

  • State recurring appropriations: $134.0M (FY26) + $357.34M (FY27).
  • Federal match estimated: $244.75M (FY26) + $652.66M (FY27).
  • Programmatic impact: immediate expansion of community waiver capacity for up to 10,000 additional beneficiaries across two years; expected to reduce waiting list growth and enable family caregivers to re-enter workforce.
  • Economic effect (per cited academic analysis): each waiver slot ≈ 1.3 jobs created locally; $1 state investment in direct care plus federal match yields ~ $5 of local economic activity.

Considerations / risks

  • Implementation depends on CMS approval of waiver changes and on provider capacity to scale services quickly.
  • Wage requirement tied to redistribution may influence where slots are ultimately deployed.
  • The recurring nature of the appropriations commits future state budget capacity for ongoing slot funding and federal match.

Compiled from official sources — confirm details with the bill’s official record.

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