The Coalition submitted the 2023 Legislative Budget Priorities to the members of the North Carolina House and Senate Appropriation Committee members. The budget requests include the following:

Support and Sustain the MH/DD/SAS Workforce

• Increase direct support and peer services provider rates by 35% to attract and retain peer and direct support professionals, raise the lowest pay levels to 18.00 per hour, and tie the rates to the cost index most appropriate to the rise in labor and provider costs to ensure labor market parity for community-based services. $87 million recurring
• Increase SUD and MH services provider rates by 30% to attract and retain a quality substance use workforce and tie annual rate increases to the cost index most appropriate to the rise in labor and provider costs. $25 million recurring
• Work with stakeholders, including community colleges and universities, to develop a loan forgiveness program as part of a comprehensive behavioral health and developmental professional recruitment strategy for North Carolina. $8 million recurring

Increase Access to Community-Based Services, Reduce Crisis, Reduce Reliance on Institutions

• Increase single-stream funding for critical behavioral health and I/DD services. $75 million recurring, for 5 years.
• Increase access to the Innovations Waiver by 2,000 slots per year to reduce the waitlist for these critical services for individuals with IDD. $48 million recurring
• Expand TBI eligibility across MCOs to develop a statewide TBI waiver program as outlined in previous legislation.
• Create a preemptive dedicated funding stream within any future Cannabis and/or gambling expansion bills that pass General Assembly to ensure that 25% of revenues are dedicated to addiction services including primary prevention, harm reduction, treatment, and recovery support services.
• Fund access to services for children with complex needs, often 3-21 year olds, whose developmental and behavioral needs must be addressed with intensive specialized services like wrap around supports, complex care management, NC START, IDD Medical Health Home pilots, kinship supports and home respite. Create consistent access to Medicaid for complex children with a TEFRA waiver under the Child and Family Services Plan Tailored Plan $ 6 million recurring for complex needs programs,18 million recurring to expand Medicaid access under TEFRA waiver
• Expand affordable housing options for persons with disabilities: Create state Office of Housing to develop and coordinate a comprehensive strategy around housing for people with disabilities. $250,000 recurring.
• Fund programs for students with disabilities needing specialty education: Funding for private school programs focused on severe behavioral health services (H771 sponsored by Rep Lofton) and additional school psychologists. $1 million recurring
• Fund school-based behavioral health services for students to address the increase in suicidality, mental health and substance use issues and support students with disabilities in remaining in school, increasing graduation rates. $100 million recurring
• Develop service definitions that increase family support, such as Coordinated Caregiving, Personal Assistance, or other options to Innovations waiver programs,1915i services, and state funded services. $15 million recurring

Invest in the MH/IDD/SUD system to provide services to those without
public or private health care coverage

• Address substance use disorders. Provide funding to address substance use disorder primary prevention as well as addiction treatment services to address gaps in the current continuum of care. $28.5 million recurring
• Increase access to local SUD programs by increasing local ABC funding distribution: Maintain controlled ABC system with an increase in the local board distribution requirement from 7% to 10%, with 3% earmarked for primary prevention. Significantly increased ABC revenues should be focused on greater access to services.
• Increase funding for Treatment Accountability for Safer Communities (TASC). Decrease caseload size and provide effective and efficient clinical supervision, oversight and training. $4.1 million recurring
• Fund treatment services, staffing, and national accreditation of jail and prison based mental health treatment services. Fund additional staffing for jail inspectors. Increase funding for Juvenile Justice programs and staffing. Pilot jail diversion programs across the state at an average cost of $50,000 per pilot
• Develop reentry initiative for people with IDD who are leaving prison and implement Medicaid suspension program for people in county jails. $300,000 recurring
• Expand family support provided through community organizations that fill needs for non-clinical, crucial determinants of health and supports not covered by Medicaid dollars. $400,000 recurring
• Increase funding for three-way psychiatric bed contracts with community hospitals to ensure access to crisis behavioral health care for those without insurance. $25 million recurring

Provide a basic level of health care for the uninsured

• Close the health insurance gap by enacting Medicaid Expansion for coverage and services to 600,000 individuals including 150,000 individuals with opioid addiction and other behavioral health needs. Cost neutral to North Carolina with the federal government paying 90 percent of the costs, makes better use of state funds already being spent for uninsured health care.