Bill
HB 1147
HB 1147 prioritizes expanding and funding supports for people with IDD, including higher direct care wages, more waiver slots, and integrated housing and transportation options.
Purpose and overarching intent
- HB 1147 is a multi-part measure designed to implement recommendations from the Legislative Joint Caucus for Intellectual and Developmental Disabilities.
- The bill aims to improve living, employment, education, housing, and transportation supports for individuals with intellectual and developmental disabilities (IDD) across state programs and services.
- Key goals include increasing direct care wages, expanding Innovations waiver slots, updating Medicaid Buy-In for workers with disabilities, adding new community-based services, expanding rental assistance, enhancing supports for students with disabilities, and creating an Office of Accessible Transportation.
Section-by-section overview
PART I. DIRECT CARE WORKER WAGE INCREASES
- Intent: Raise direct care worker wages to a minimum of $18.00/hour.
- What DHB must do: Provide Medicaid rate increases to:
- Home- and community-based providers enrolled in Medicaid.
- ICF/IID facilities and ICF/IID-level group homes.
- Providers serving beneficiaries under NC Innovations waiver, CAP/C, CAP/DA, 1915(i) options (Supported Employment, Respite, Community Living and Supports, Community Transition), and related billing arrangements.
- Administration and oversight:
- DHB, with a workgroup, will define “direct care worker” and determine the exact rate amount and utilization requirements (documentation, etc.).
- Rate increases become effective on CMS approval date; PMPM capitation adjustments to relevant LME/MCOs and the Children and Families Specialty Plan.
- Recoupment allowed if funds are not used for direct care workers.
- Funding: $183 million in recurring General Fund appropriations starting in FY 2026-2027.
- Effective date: July 1, 2026.
PART II. FUND ADDITIONAL INNOVATIONS WAIVER SLOTS AND DEVELOP A 10-YEAR PLAN TO ADDRESS THE REGISTRY OF UNMET NEEDS
- Waiver expansion: Add at least 1,000 NC Innovations waiver slots, contingent on CMS approval.
- Funding: $36.2 million in recurring funds starting FY 2026-2027 to create additional slots.
- Planning requirement: DHB must convene a stakeholder workgroup to develop a 10-year plan addressing the registry of unmet needs (considering 1915(i) services and potential alternative slot distribution). The plan must include a cost analysis and be submitted to the Joint Legislative Oversight Committee by Feb 1, 2026.
- Effective date for subsections (a)-(b): July 1, 2026.
PART III. UPDATE TO NC MEDICAID BUY-IN PROGRAM
- Timeline: Within 90 days of enactment, DHHS/DHB must seek CMS approval to remove unearned income limit and resource limit for Health Coverage for Workers with Disabilities (HCWD).
- Eligibility changes: No longer consider certain income exclusions; maintain eligibility for workers with disabilities (16-64), with protections against loss of eligibility solely due to employment (permitted under federal rules).
- Fees and premiums: Revisions to enrollment fees and sliding-scale premiums based on income; co-pays remain aligned with Medicaid.
- Effective date for removal of limits: Tied to CMS approval.
- Additional funding: $165,000 recurring in FY 2026-2027 to support these changes.
- Effective date: July 1, 2026 (for related sections).
PART IV. MEDICAID COMMUNITY ACTIVITIES AND EMPLOYMENT TRANSITIONS SERVICES (CAET)
- Feasibility study: DHB to study adding CAET as a Medicaid service (in-lieu-of 1115 waiver, 1915(i) State Plan, or other waivers).
- Service criteria: Modeled after Long-Term Community Supports (nonresidential), similar to services from Vaya Health and Alliance Behavioral Healthcare; no residential component; must originate from compliant facilities.
- Stakeholder collaboration: Includes MARC, NCARF, NCAPSE, and LME/MCOs; potential rule changes by the Commission for Mental Health, DD, and Substance Abuse Services.
- Implementation and cost: If feasible, submit State Plan amendments or waivers; coverage not before Jan 1, 2027.
- Feasibility funding: $2,000,000 nonrecurring in 2026-2027 to study CAET and draft implementation authorities.
- Effective date: July 1, 2026 (study funding).
PART V. STATE RENTAL ASSISTANCE PROGRAM (SRAP) FOR IDD HOUSING
- Purpose: Develop a State Rental Assistance Program to provide housing vouchers to help individuals with IDD transition to integrated housing (per the 2024 Olmstead consent order).
- Funding: $100,000 recurring starting FY 2026-2027 to support the program.
- Five-year plan: Create 200 new monthly subsidies per year (total 1,000 subsidies over five years); assess comparable programs in other states; submit plan by Oct 1, 2026.
- Oversight: Plan aligned with Olmstead obligations.
PART VI. STATE MATCH FOR RSA (REHABILITATION SERVICES ADMINISTRATION) FEDERAL GRANT
- Funding:
- DEIPD: $4,755,071 recurring to increase pay, address vacancies, raise rates for Community Rehabilitation Programs; leverage $17,569,204 in recurring federal funds.
- DSB: $995,163 recurring to address vacancies and sustain vocational rehabilitation workforce; leverage $3,676,959 in recurring federal funds.
- Effective: July 1, 2026.
PART VII. BAN USE OF PRONE RESTRAINT AND REQUIRE INCREASED PARENTAL NOTIFICATION AND TEACHER TRAINING ON RESTRAINT AND SECLUSION
- School policy updates: Prohibits prone physical restraint of students.
- Training and reporting: Requires at least eight continuing education credits for teachers (minimum three in subject area; at least one on seclusion/restraint policies).
- Notification: Schools must inform parents at year start and promptly notify about incidents, with defined timelines (end of the workday and follow-up contact information).
- Effective: Beginning with the 2026-2027 school year.
PART VIII. DASHBOARD FOR SUSPENSION RATES FOR STUDENTS WITH IEPS
- Reporting enhancements: State Board must publish disaggregated data on suspensions, expulsions, alternative placements, and related metrics by local unit, race, gender, grade, ethnicity, and disability status; public dashboard required.
- Effective: 2026-2027 school year.
PART IX. ADDITIONAL FUNDS FOR NC PERSONAL EDUCATION STUDENT ACCOUNTS FOR CHILDREN WITH DISABILITIES
- Funding: $25,000,000 recurring to UNC Board of Governors for allocation to the NC Personal Education Student Accounts for Children with Disabilities Program (Article 41, Chapter 115C).
- Long-range growth schedule: Annual increases in baseline funding through 2032-2033, with specified amounts for each year.
- Effective: July 1, 2026.
PART X. SUPPORT FOR STUDENTS WITH DISABILITIES
- 2026-2027 onward: DPI to establish a grant program from the Special State Reserve Fund to cover extraordinary costs for students with disabilities (including private school placements) under IEPs.
- Eligibility and funding: Grants cover up to 75% of extraordinary costs; student-specific; requires detailed documentation; units remain responsible for FAPE in the LRE.
- Oversight and reporting: DPI to monitor and report grant activity, expenditures, and placement types; annual reporting requirements begin in 2027.
- Appropriation: $1,000,000 recurring beginning 2026-2027.
- Effective: July 1, 2026.
PART XI. DEVELOP AN OFFICE FOR ACCESSIBLE TRANSPORTATION
- DOT Office: Create and administer the Office of Accessible Transportation and Mobility within the Department of Transportation.
- Purpose and coordination: Improve accessible transportation statewide; cross-agency coordination; stakeholder engagement with consumer and transportation expertise.
- Reporting: By March 31, 2027, deliver a mission/scope statement and a five-year strategic plan to appropriations and fiscal committees.
PART XII. EFFECTIVE DATE
- General effective date: The act becomes law, with specific sections taking effect as noted above.
Potential impact and scope
- Economic: Substantial funding to raise direct care wages, expand waiver slots, support employment services, housing subsidies, and specialized education funding.
- Service delivery: Expanded Medicaid services (CAET), CAET feasibility, HCWD program modernization, and new transportation coordination could broaden supports for IDD individuals.
- Education: Strengthened in-school restraint/seclusion policies, data transparency, and higher education funding targeted at students with disabilities.
- Housing and community living: Increased rental subsidies and mobility options align with Olmstead obligations to promote integrated living.
- Oversight and reporting: Expanded dashboards and annual reporting requirements to monitor outcomes, safety, and program effectiveness.
Notes
- The bill includes multiple appropriations and requires CMS approval for several Medicaid-related changes.
- Several sections are contingent on federal authorization or CMS approvals and are phased in from July 1, 2026 or later.
Compiled from official sources — confirm details with the bill’s official record.
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