Bill
HB 933
Raises direct care worker wages to at least $18/hour by boosting Medicaid payments to providers, backed by state/federal funds and CMS-approved implementation.
Status: Introduced (House Bill H.B. 933, 2025 session). Primary sponsor: Rep. Hawkins. Referred to Appropriations (if favorable), Finance, Rules, Calendar, and Operations of the House. Filed April 2025.
To implement a package of policies recommended by the Legislative Joint Caucus for Intellectual and Developmental Disabilities aimed at improving wages for direct care workers, expanding waiver access for people with IDD, and removing barriers in Medicaid buy‑in rules for workers with disabilities.
Part I — Direct Care Worker Wage Increases
- Intent: raise direct care worker wages to a minimum of $18.00 per hour.
- The Department of Health and Human Services, Division of Health Benefits (DHB), must provide Medicaid rate increases to:
- Home- and community‑based Medicaid providers;
- Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IIDs), including group homes;
- Providers serving beneficiaries under the NC Innovations waiver, CAP/C, CAP/DA, and certain 1915(i) services — including consumer-directed arrangements and employers of record.
- DHB will convene a provider workgroup to define “direct care worker,” set the rate increases, determine required documentation showing the increased rates were used for worker compensation, and set monitoring requirements.
- Rate increases take effect on the date approved by CMS. DHB must adjust PMPM capitation paid to LME/MCOs and require LME/MCOs (including BH IDD tailored plans) to implement the increases.
- DHB or LME/MCOs may recoup funds if increases are not used to benefit direct care workers.
Budget appropriation (Part I)
- $183,000,000 recurring State funds annually for each year of the 2025–2027 biennium to provide the State match. This is intended to draw $335,000,000 recurring federal funds annually (total recurring funding each year: $518M).
Part II — Innovations Waiver Slots & 10‑Year Plan
- DHB must amend the NC Innovations waiver to add at least 1,000 new slots (subject to CMS approval).
- Appropriation: $36,000,000 recurring State funds annually (2025–2027) to match $65,000,000 recurring federal funds.
- DHB to convene a stakeholder workgroup to develop a 10‑year plan to eliminate the registry of unmet needs; plan must include cost analysis and be submitted to the Joint Legislative Oversight Committee on Medicaid by February 1, 2026.
Part III — Medicaid Buy‑In (Health Coverage for Workers with Disabilities)
- Within 90 days of enactment, DHB must submit documentation to CMS seeking removal of the HCWD unearned income and resource limits. Changes take effect upon CMS approval; DHB will notify the Revisor of Statutes of the CMS‑approved effective date.
If you want, I can produce a one‑page fact sheet for providers, a timeline chart, or extract the bill language that defines eligible provider types and documentation requirements.
Compiled from official sources — confirm details with the bill’s official record.
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