2025 NASW-NC Legislative Session Update: Trump DOJ sues NC Board of Elections

In this week's update:

• Trump DOJ sues NC Board of Elections 
• Trump denies NC FEMA request again 
• NC House budget reduces HHS positions, tweaks Medicaid funding
• CMS Increasing Oversight on Using Medicaid for non-US citizens
• Black Youth Suicide Prevention Action Plan -Public Comment 
• Social Work Compact passes Senate Health Care Committee
• NASW-NC Bill Tracker
• NASW-NC Clinical Supervision Certificate Training

Trump DOJ sues NC Board of Elections    

The Trump administration accused North Carolina’s election board on Tuesday of violating federal law by failing to ensure voter registration records of some applicants contained identifying numbers. The Justice Department sued in federal court also asking a judge to force board officials to create a prompt method to obtain such numbers.

The department alleges that the state and the board aren’t complying with the 2003 Help America Vote Act after board officials provided a statewide voter registration form that didn’t make clear an applicant must provide either a driver’s license number or the last four digits of a Social Security number. If an applicant lacks neither, the state must assign the person another unique number.

A previous edition of the state board, in which Democrats held a majority, acknowledged the problem in late 2023 after some voters complained. The board updated the form but declined to contact people who had registered to vote since 2004 in time for the 2024 elections so they could fill in the missing numbers.

According to the lawsuit, the board indicated that such information would be accumulated on an ad hoc basis as voters appeared at polling places. It’s unclear exactly how many voters’ records still lack identifying numbers.

Lawyers from the department’s Civil Rights Division contend the board must act more aggressively. They want a judge to give the state 30 days to contact voters with records that don’t comply with federal law, obtain an identifying number for each and add that to the electronic list. The litigation follows similar efforts by the Republican Party and a state GOP candidate to address the registration records for the 2024 election.

The lawsuit also referred to President Donald Trump’s broad executive order on elections in March to “guard against illegal voting, unlawful discrimination, and other forms of fraud, error, or suspicion.”

This month, the board’s composition changed to reflect a 2024 law approved by the GOP-dominated General Assembly that shifted the board’s appointment powers from the now-Democratic governor to Republican State Auditor Dave Boliek. A previous 3-2 Democratic majority is now a 3-2 Republican majority.

The new iteration of the board sounds open to embrace the Justice Department’s wishes. Executive Director Sam Hayes said late Tuesday the lawsuit was being reviewed, but the failure to collect the information required by HAVA has been well documented. Rest assured that I am committed to bringing North Carolina into compliance with federal law.”
(Source)

Trump denies NC FEMA request again          

The Federal Emergency Management Agency has denied North Carolina’s latest request for a 180-day extension of the 100% cost match for eligible Tropical Storm Helene recovery expenses.

In a May 22 letter to North Carolina Gov. Josh Stein, FEMA’s acting administrator David Richardson said the extension was “not warranted” based on a “careful and thorough review.”

In April, the agency first denied the state's request under then-acting administrator Cameron Hamilton. Stein appealed the decision.

In March, the federal match dropped to 90% for eligible expenses, like debris removal, with the state and local government responsible for the remaining costs. In December, then-President Joe Biden had increased the federal cost share for public assistance projects from 75% to 90% after the 180-day period.

“FEMA’s denial of our appeal will cost North Carolina taxpayers potentially hundreds of millions of dollars to clean up out west (Western North Carolina),” Stein said in a May 23 statement responding to FEMA’s decision. “The money we have to pay toward debris removal will mean less money towards supporting our small businesses, rebuilding downtown infrastructure, repairing our water and sewer systems, and other critical needs.”

In January, President Donald Trump visited Western North Carolina and said “the days of betrayal and neglect are over” for a region still reeling amid unprecedented devastation. During a press conference in Swannanoa, Trump said he might eliminate FEMA and accused Biden of failing the people of North Carolina after the storm.

In February, Stein formally requested the extension of the 100% federal cost share for debris removal and emergency protective measures, including direct federal assistance for 180 additional days.

At the time, Hamilton, who was later removed from his position after he said he opposed abolishing FEMA during a House committee hearing, said the extension request was “not warranted” based on the agency’s review.

“FEMA initially provided a 100% federal cost share to incentivize speedy debris removal operations and recovery,” a FEMA spokesperson told the Citizen Times in an April 16 email. “The typical assistance FEMA provides through its Public Assistance Program is 75%, due to the severity of the disaster with Hurricane Helene, FEMA is providing North Carolina 90% far exceeding the normal 75%.”

Still, without the 100% cost-share extension, Stein has estimated that the state and local governments could be responsible for upward of $200 million in additional costs.

“I have seen how much you care about the people of this region and know that you are committed to helping them rebuild their lives,” Stein wrote to Trump in April, appealing FEMA’s initial denial. “Please give them the tools they need to help their home region come back even better than before.” 
[Source]
 

Click Here to Read Governor Stein's statement after FEMA's denial of Hurricane Helene recovery efforts. 

NC House budget reduces HHS positions, tweaks Medicaid funding       

The North Carolina House of Representatives approved a budget plan on May 22 for the next two fiscal years that would cut some vacant positions in the health department, loosen child care regulations and eliminate Medicaid coverage of GLP-1 drugs, such as Ozempic, for weight loss.

The House’s budget plan came about a month after the N.C. Senate released theirs. Both the House and Senate spending plans increase rates for child care subsidies so that low income families with children can work, and they cut funding to a Medicaid pilot program that has drawn national attention and praise. 

The House’s plan would spend far less than the Senate’s on a new children’s hospital. 

The two chambers of the General Assembly also have plans that differ on taxes; the Senate’s plan would reduce the income tax rate for North Carolinians from 4.25 percent to 3.99 in 2026 and 3.49 percent in 2027. That would mean overriding rules set in place to restrict tax cuts based on revenue levels. Meanwhile, the House’s plan would keep the planned reduction to 3.99 percent in 2026 but raise the threshold for approving continued tax cuts after that.

The chambers will have to hash out their different visions for state spending over the next few weeks, a process that usually takes place behind closed doors. The budget is due by June 30, the end of the fiscal year, but lawmakers often miss that target. A change to state law made in the 2018 budget means that after the new fiscal year starts, the prior year’s numbers apply to state spending until a new plan is ratified.

Rep. Donny Lambeth (R-Winston Salem) said during a news conference on May 19 that the uncertainty around federal funding streams made it “a challenge” to figure out the Department of Health and Human Services section of the state budget.

The U.S. House of Representatives passed a reconciliation bill on May 22 that cuts roughly $700 billion in Medicaid over a decade. While hefty, the proposed cuts aren’t as bad as some anticipated, Lambeth said. If a federal budget does get passed soon, state lawmakers will have to figure out how to deal with any reductions, he said.

North Carolina House Republicans said the chamber’s budget process was transparent and involved feedback from stakeholders and House Democrats to create a plan that involves “historic” increases for public school teachers. But Rep. Marcia Morey (D-Durham) said at a news conference on May 20 that the plan “robs from Peter to pay Paul” by cutting vacant positions to achieve savings.

Under the House’s plan, most state employees would receive a 2.5 percent average salary increase. It would also bump the state base pay for starting public school teachers from $41,000 to $48,000 this year and $50,000 next year. Over the next two years, the average teacher salary increase would work out to 8.7 percent, Rep. Erin Paré (R-Holly Springs) claimed at the news conference. Newer teachers would get much larger percentage increases than more experienced teachers, according to state budget documents.

Healthy Opportunities on the chopping block

The House and Senate spending plans both effectively cut funding for the Healthy Opportunities Program, a Medicaid pilot project that provides services to people in three rural areas of the state. Since its launch in 2022, the program has provided assistance to nearly 30,000 people and drawn national interest.

Beneficiaries are eligible for deliveries of food, rides to doctor’s appointments and other services designed to combat social, economic and geographic issues that contribute to poor health outcomes and increased cost.

Lambeth said the concept of Healthy Opportunities is “really good.” But he hasn’t seen compelling evidence of the cost savings the program promises to create.

Rep. Eric Ager (D-Fairview) said during the initial House budget vote on May 21 that Healthy Opportunities has had “a huge impact” on his district in Buncombe County. 

“If people can live in a safe house and get good food and have a car to go to work…they do the things they need to do before they get really sick,” he said.

Rep. Rodney Pierce (D-Roanoke Rapids) also spoke in favor of the program, noting how it was the first of its kind in the country. In his district, the program gave people access to fresh fruits and vegetables, he said. (One out of four children is food insecure in northeastern N.C.)

Failing to invest in Healthy Opportunities and eliminating Medicaid coverage for weight-loss medications such as GLP-1 drugs “will raise long-term healthcare costs and lead to more hospitalizations, complications, and preventable deaths,” a DHHS spokesperson said.

Medicaid rebase

Medicaid, the state- and federally funded program that provides health care services for more than 3 million North Carolinians, has costs that fluctuate each year based on the number of beneficiaries and the cost of their care. The state health department creates an annual forecast of how costs might change and asks the legislature for funding adjustments based on those predictions — known as the “rebase.”

The budget presented last month by Gov. Josh Stein funded that rebase to the tune of $700 million. But the House and Senate spending plans allot only $500 million for the rebase. 

According to a DHHS spokesperson, the House budget falls short of what’s needed for the rebase.

“There is a disagreement between central staff at the General Assembly and the governor’s office as to what is rebase and what’s included,” budget crafter Sen. Ralph Hise (R-Spruce Pine) argued.

Other Medicaid tweaks

The House’s budget proposal also eliminates the Medicaid Contingency Reserve, a pot of money set aside for times when the Medicaid program needs less or more money than expected. The budget would transfer the roughly $970 million currently in the reserve to the State Emergency Response and Disaster Relief Fund. 

Lambeth said budget writers decided to consolidate some of the reserves to replenish the savings and disaster relief funds.

Rep. Tracy Clark (D-Greensboro) argued during the initial House budget vote on May 21 that the state should keep those funds in place, given the uncertainty of federal funding for Medicaid. The program covers four of every 10 births in the U.S., she said, among other vital functions.

The reserve reassures beneficiaries, providers, health plans and vendors that there is a financial safety net, a DHHS spokesperson said. There are “significant concerns” with zeroing out the fund with uncertainty around federal Medicaid funding, potentially underfunding the Medicaid rebase at the state level and the ongoing Helene recovery process, the spokesperson also said.

The House budget proposal would also cut roughly $20 million each year in state dollars for the state-authorized regional mental health services management organizations, known as LME-MCOs. The Senate plan proposed larger cuts.

LME-MCOs use these funds for services to help uninsured and underinsured people with mental health, substance use and intellectual and developmental disabilities, among other needs, according to DHHS. The funds also support mental health crisis services for people without a way to pay for care.

Rep. Sarah Crawford (D-Raleigh) said on the House floor during the budget debate on May 22 that the cuts would hurt the organizations’ ability to provide those services. Some of those dollars support people with services while they wait to get off the decade-long waitlist for N.C. Innovations, a Medicaid program that connects direct support professionals to residents who are unable to live independently without this type of assistance. 

Vacant position cuts    

The House’s spending plan would also require the state health department to cut enough vacant positions to save $10 million each year from 2025 to 2027— but not cut positions from the Division of Aging, Division of Public Health or the Division of State-Operated Health Care Facilities, which manages the state’s psychiatric facilities.

The lapsed salary money from cut vacancies would be redirected to a pot of money where the funds can be used to increase existing employees’ salaries to improve recruitment and retention.

Lambeth said DHHS asked for more flexibility with salary money. The department was also using some of the lapsed salary money to pay for other programs, so the budget would help make sure personnel money is going where it should, he said.

The state-operated health care facilities have struggled to recruit health care staff, but managers of those facilities have tended to use money from the unpaid salaries to fill in the gaps by hiring contract workers, who are often more expensive than state employees.

Charles Owens, a health care technician at state-operated Cherry Hospital, said the facility is short-staffed and people often work overtime. Public workers such as himself aren’t taken care of by legislators, he said.

Child care changes

The House budget would also use federal block grant funds to increase child care subsidy reimbursement rates. Child care subsidies help eligible low-income families pay for child care so parents can go to work.

The rate increase is much needed, because inflation and labor costs have put more and more pressure on child care providers in the past couple of years, said Charles Hodges, director of the NC Licensed Child Care Association. Costs have kept going up since the 2023 study was completed, he said.

Parents receiving the subsidy are currently required to pay 10 percent of their income for child care. This bill would decrease that cost sharing to only 7 percent.

The budget plan also contains language from House Bill 412, which passed the House on April 15. One provision directs NC DHHS to propose a plan to decouple the child care subsidy payments from the state’s system for rating the quality of child care facilities.

Currently, licensed child care centers are rated from one to five stars using a point system based on program and education standards. Child care subsidy funds help eligible families afford child care programs that have earned three or more stars, along with religiously sponsored programs that meet health and safety standards.

The bill would also allow a lead teacher, or someone who’s more highly qualified, to oversee two groups instead of one. Another provision would increase the maximum group size for 0- to 12-month-olds from 10 to 15 children, and for 12- to 24-month-olds from 12 to 18 children. The staff ratio would remain the same.

Aging health

The House budget bill also includes language from House Bill 485, which passed the House April 16. The measure would direct NC DHHS to ask the Centers for Medicare and Medicaid Services to extend Medicaid eligibility to cover personal care services for eligible residents of adult care homes, or assisted living facilities. Personal care services include help with daily activities like bathing, eating and dressing.

Currently, people must be under a certain income limit to qualify for Medicaid to cover personal care services, but that income level was flat from 2008 to 2022 with only small increases since, said Jeff Horton, executive director of the NC Senior Living Association, an advocacy organization for adult and care homes. One of his members said they turn away three to four families a month who are just over the limit. 

If made law, this provision would allow more people to access Medicaid for those services and therefore allow assisted living facilities to take in more people, Horton said.

The House budget would also fund four more regional long-term care ombudsmen, or advocates for residents of long-term care facilities like nursing homes. Aging advocates had been hoping for 10 new ombudsmen, but four “is a very good start,” said Mary Bethel, chair of the board of directors for the North Carolina Coalition on Aging.

The federal funding for the ombudsman program is at risk, she said. Ombudsmen can help resolve conflicts between residents and facilities before they have to go to state regulators.

The House budget did not cut state funding for the Senior Health Insurance Information Program, which the Senate plan had proposed. The program provides free, unbiased Medicare counseling for older adults in the state and is heavily used by seniors during the annual Medicare enrollment period.

The program is essential for Medicare beneficiaries in the state, Bethel said. Federal funding for this program is at risk, so to lose state funding as well would be “devastating,” she said.

Other items

• Reorganizes the Office of Health Equity into the Division of Public Health. The office works on the elimination of health disparities and the improvement of health access issues.
• Includes language from House Bill 434, which passed April 30, that would restrict health insurers’ use of the prior authorization process, where insurance companies require patients and doctors to follow specific and sometimes lengthy procedures before they’ll approve some treatments, tests or doctor visits.
• Includes language from House Bill 297, which passed May 7, that would require insurance companies to expand covered screenings for breast cancer, including mammograms and other imaging.
• Increases Medicaid reimbursement rates by 3 percent for providers, including speech-language therapy services, optical and optometry services, podiatry services, clinical pharmacists, nurse midwives and chiropractic services.

(Source: NC Health News by Grace Vitaglione)

CMS Increasing Oversight on Using Medicaid for non-US citizens

The Centers for Medicare & Medicaid Services (CMS) announced today increased federal oversight to stop states from misusing federal Medicaid dollars to cover health care for individuals who are in the country illegally. Under federal law, federal Medicaid funding is generally only available for emergency medical services for noncitizens with unsatisfactory immigration status who would otherwise be Medicaid-eligible, but some states have pushed the boundaries, putting taxpayers on the hook for benefits that are not allowed.

“Medicaid is not, and cannot be, a backdoor pathway to subsidize open borders,” said CMS Administrator Dr. Mehmet Oz. “States have a duty to uphold the law and protect taxpayer funds. We are putting them on notice—CMS will not allow federal dollars to be diverted to cover those who are not lawfully eligible.”

As part of the action, CMS is ramping up financial oversight across the board to identify and stop improper spending. This includes:
• Focused evaluations of select state Medicaid spending reports (CMS-64 form submissions);
• In-depth reviews of select states’ financial management systems; and
• Assessing existing eligibility rules and policies to close loopholes and strengthen enforcement. 
“Medicaid funds must serve American citizens in need and those legally entitled to benefits,” said CMS Deputy Administrator and Director of the Center for Medicaid & CHIP Services Drew Snyder. “If states cannot or will not comply, CMS will step in.”
CMS is also urging all states to immediately examine and update internal controls, eligibility systems, and cost allocation policies to ensure full compliance with federal law. Any improper spending on noncitizens will be subject to recoupment of the federal share.

The letter to states is available at: https://www.cms.gov/files/document/open-borders-eo-notification-states.pdf
 

Black Youth Suicide Prevention Action Plan -Public Comment

NCDHHS and DMH/DD/SUS is partnering with DPH, UNC SPI, DPI and Village of Care on the development of a strategic plan dedicated to preventing suicide among Black youth.  

This is the first strategic plan of its kind in the history of NCDHHS and DMH/DD/SUS. We invite your input to make this the strongest plan possible and are seeking public comment on a draft of the plan. 

After reading the plan, please share your thoughts by filling out the feedback form by Friday, June 6, 2025.  

Social Work Compact passes Senate Health Care Committee

On Wednesday, May 21st, HB 231 -Social Work Interstate Licensure Compact unanimously passed the NC Senate Health Care Committee. NASW-NC’s Executive Director, Valerie Arendt and Director of Advocacy and Policy, Lauren Zingraff, along with NC Social Work Certification and Licensure Board Executive Director Elizabeth Pope were present at the NC General Assembly for the vote. 

HB 231 has been favorably referred to the NC Senate Finance Committee next.  After it passes the Finance Committee, it will be referred to the Senate Rules Committee. Senate Rules is the final committee before a full vote on the NC Senate Floor.  If it passes the Senate, as it did the NC House, it will go to Governor Stein’s desk for his signature. 

The NC General Assembly is on a break during the week of May 26-30th.  We anticipate the Senate Finance Committee to meet again in June when they return. 

The Social Work Licensure Compact has been enacted in at least seven states and has reached activation status; however, multistate licenses are NOT yet being issued.  The implementation process for the compact will take 12 to 24 months before multistate licenses are to be issued. You can learn more details about the Social Work Licensure Compact and the Compact Commission by going to its website here. 

NASW-NC is the ONLY organization lobbying and advocating for the entire Social Work Profession at the North Carolina Legislature. The NASW-NC lobbying team would not exist without the incredible support of NASW-NC membership. If you are already a member of NASW-NC, THANK YOU. Our members are the only reason that we have been able to do this work! 

NASW-NC is not federally funded; we are not state-funded. We are funded by the members of NASW and will not exist to advocate for you and the social work profession without YOU!  We are able to do more if we have a large voice and robust membership. If you are not yet a member, please join NASW and join us in our advocacy efforts.      

You can watch HB 231 pass the Senate Health Care Committee HERE. 

Follow updates on the Social Work Compact in the NC General Assembly here. 

NASW-NC Bill Tracker

NASW-NC has created a page to keep members up to date with legislative developments regarding the Social Work Interstate Licensure Compact, restoring master’s level pay for school social workers, and other bills related to the social work profession.

NASW-NC is currently keeping an eye on more than 100 bills that, if passed, may impact the social work profession and the populations we serve. You can view all of the bills NASW-NC is tracking at the NC General Assembly HERE. 

2025 NASW-NC Clinical Supervision Certificate Training

Thousands of LCSWAs in North Carolina need quality clinical social work supervision. Now it is your turn to help grow our clinical social work workforce! Earn your NASW-NC Clinical Supervision Certificate and gain 18 Continuing Education Contact Hours! Topics include supervisory styles and techniques, skills to supervise clinical social workers at various stages of clinical development, managing challenging supervisees and situations, evaluating clinician competency, cultural competency, ethics, legal and regulatory issues, and much more! 

June 9-11, 2025
Virtual 
Up to 18 hours of CE

Registration Fees:
Members $150
Not yet a member? $300
Exam fee $50

See full agenda and register here!

Thank you to the members of NASW-NC for supporting the advocacy work we do. We would not be able to advocate for the social work profession or social justice issues in North Carolina without a robust and engaged NASW membership. 

Learn more about NASW-NC membership here.

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