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

GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2025
S 1
SENATE BILL 246

Short Title: Create 13,000 Jobs Serving People With I/DD. (Public)
Sponsors: Senators Grafstein and Moffitt (Primary Sponsors).
Referred to: Rules and Operations of the Senate
March 6, 2025
*S246-v-1*
A BILL TO BE ENTITLED 1
AN ACT TO INCREASE THE AMOUNT OF MEDICAID INNOVATIONS WAIVER SLOTS 2
AVAILABLE FOR THE 2025-2027 FISCAL BIENNIUM. 3
Whereas, the Innovations Waiver provides critical services to about 15,000 North 4
Carolinians with intellectual and/or developmental disabilities, allowing them to receive support 5
for living in their home communities and enabling their families to remain in the workforce; and 6
Whereas, there are currently approximately 19,000 people with intellectual and/or 7
developmental disabilities on the waiting list for Innovations Waiver services; and 8
Whereas, the Innovations Waiver waiting list has doubled in the last 10 years; and 9
Whereas, the addition of 2,000 Innovations Waiver slots over the past 10 years has 10
failed to keep up with the pace of growth on the waiting list; and 11
Whereas, many people on the waiting list have waited more than a decade for critical 12
services; and 13
Whereas, there are people on the waiting list in every county in North Carolina; and 14
Whereas, every State dollar spent on an Innovations Waiver slot draws down 15
approximately two dollars in federal matching funds; and 16
Whereas, according to analysis by researchers at the UNC -Greensboro Department 17
of Economics, each new Innovations Waiver slot represents about 1.3 new jobs created in the 18
local community where the beneficiary lives; and 19
Whereas, according to analysis by the same researchers, every State dollar paid to 20
direct care workers, combined with the federal match, results in five dollars of local economic 21
activity; and 22
Whereas, providing needed services to people with intellectual and/or developmental 23
disabilities creates jobs and stimulates economic activity in every community in North Carolina; 24
and 25
Whereas, addressing the service needs of individuals on the waiti ng list has the 26
additional benefit of enabling family or other caregivers to resume participation in the workforce; 27
Now, therefore, 28
The General Assembly of North Carolina enacts: 29
SECTION 1.(a) There is appropriated from the General Fund to the Department of 30
Health and Human Services, Division of Health Benefits (DHB), the sum of one hundred 31
thirty-four million dollars ($134,000,000) in recurring funds for the 2025 -2026 fiscal year and 32
the sum of three hundred fifty-seven million three hundred forty thousand dollars ($357,340,000) 33
in recurring funds for the 2026 -2027 fiscal year to be used to increase the number of North 34
Carolina Innovations Waiver slots, as directed by this act. These funds shall provide a State match 35
for two hundred forty -four million seve n hundred fifty thousand dollars ($244,750,000) in 36
General Assembly Of North Carolina Session 2025
Page 2 Senate Bill 246-First Edition
recurring federal funds for the 2025-2026 fiscal year and the sum of six hundred fifty-two million 1
six hundred sixty thousand dollars ($652,660,000) in recurring federal funds for the 2026 -2027 2
fiscal year , and those federal funds are appropriated to the Division of Health Benefits for 3
implementation of this act. 4
SECTION 1.(b) DHB shall amend the North Carolina Innovations Waiver to 5
increase the number of waiver slots available under the waiver for the 202 5-2026 fiscal year by 6
5,000. These 5,000 waiver slots shall be distributed in accordance with subsection (c) of this 7
section and are to be made available October 1, 2025, unless the method of acceptance or 8
rejection of waiver slots detailed in subsection (c) of this section requires approval by the Centers 9
for Medicare and Medicaid Services (CMS). If CMS approval is required, then any waiver slots 10
that are rejected under the procedure described in subsection (c) of this section shall be made 11
available October 1, 2025, or the date that CMS grants or denies approval of the rejection and 12
acceptance procedure, whichever is later. If CMS approval is required and CMS does not approve 13
the rejection and acceptance procedure in subsection (c) of this section, then any rejected waiver 14
slots shall remain distributed using the allocation formula currently in place as of the effective 15
date of this act. 16
SECTION 1.(c) DHB shall distribute the initial 5,000 waiver slots identified under 17
subsection (b) of this section using the allocation formula currently in place as of the effective 18
date of this act, provided that all waiver slots shall be filled on a first -come, first-served basis 19
determined by the length of time an individual has been on the waiting list for an Innovation s 20
Waiver slot. Each LME/MCO shall, within 30 days of receiving the offer of the waiver slot, elect 21
whether to accept some, all, or none of the waiver slots offered. All waiver slots not accepted by 22
an LME/MCO shall be distributed equally among the LME/MCOs that attest to the following 23
requirements: 24
(1) The LME/MCO ensures that all rates paid to providers for any services 25
provided to beneficiaries receiving those services through the Innovations 26
Waiver are sufficient to pay its direct care employees a minimu m wage of 27
twenty dollars ($20.00) per hour. The LME/MCO may include in the rates 28
paid any additional amounts authorized by the General Assembly that are 29
designated for direct care personnel wages. 30
(2) The ability and capacity to provide services to the ben eficiaries that will 31
receive the additional waiver slots exists within the LME/MCO's catchment 32
area. 33
Any election by an LME/MCO to accept or reject additional waiver slots made 34
available under this section shall not impact the distribution of any waiver sl ots available in the 35
2026-2027 fiscal year. 36
SECTION 1.(d) DHB shall amend the North Carolina Innovations Waiver to 37
increase the number of waiver slots available under the waiver for the 2026 -2027 fiscal year by 38
5,000. These 5,000 waiver slots shall be dis tributed using the allocation formula currently in 39
place as of the effective date of this act; provided all waiver slots shall be filled on a first -come, 40
first-served basis determined by the length of time an individual has been on the waiting list for 41
an Innovations Waiver slot. These waiver slots shall be made available July 1, 2026. 42
SECTION 2. This act becomes effective July 1, 2025. 43