2023-2024 Public Policy & Legislative Priorities

Public policy and legislative priorities for the North Carolina Serious Illness Coalition during 2023-2024.

These priorities do not represent the entirety of the issues which the Coalition supports and on which it takes a position. The Coalition leverages the power of collective advocacy through its members and partner organizations.

Support Those Living with Serious Illness

Modernize Requirements for Advance Health Care Directives

Support legislation to modernize signature and notary requirements for health care powers of attorney and advance health care directives, and support electronic access to these documents.

Develop Palliative Care Payment Models

Support efforts to implement new palliative care payment models, including approval for Medicaid coverage for adult and pediatric palliative care.

Align NC Portable Medical Orders with National Standards

Promote efforts to align the NC MOST (Medical Orders for Scope of Treatment) with the national POLST (Portable Medical Orders) and to allow MOST to be signed, documented, accepted and stored in electronic form to support transportability and access when needed.

Expand Access to Care

Stabilize the Direct Care Workforce Crisis

Support efforts to recruit and retain essential frontline workers. Make permanent the temporary rate increases for Medicaid and State/County Special Assistance (SA) put in place during COVID-19 to move the direct care workforce toward a living wage. In addition, adopt initiatives to improve benefits and support for direct care workers, including efforts to help workers take control of their financial future, such as through supporting NC Work & Save legislation.

Expand Medicaid

Support legislation that will close the health insurance coverage gap in North Carolina and provide access to affordable coverage to 600,000 individuals living in the coverage gap. Prioritizing affordable healthcare is a critical step the state can take to achieve health equity for all North Carolinians.

Authorize Full Practice Authority for Advanced Practice Registered Nurses

Support The SAVE Act. Bring North Carolina in line with long-established national standards by modernizing regulations to allow Advanced Practice Registered Nurses (APRNs) to work to the full extent of their training and education; thus improving North Carolina’s healthcare system to deliver better care, faster access, and lower costs.

Strengthen Telehealth

Support legislation to develop comprehensive statewide telehealth policies and clear implementation guidelines that will improve access to quality health care for all North Carolinians. Barriers to full use of telehealth such as access to high-speed internet (also known as broadband) and other communication technologies in rural areas must be addressed.

Ensure Comprehensive Aging Planning

Support the development of a NC Master Aging Plan & NC Division of Aging and Adult Services (DAAS) State Aging Services Plan, outlining the challenges and opportunities of North Carolina’s increasing older adult population. Ensure there is focus on the implications of an aging baby boomer population, support for personal responsibility, importance of family caregivers across the lifespan, and the promotion of health equity and inclusion in access and delivery of healthcare and community-based services and supports.

Provide Adequate Recurring Funding for Home & Community Based Services

Provide adequate recurring funding for home and community-based services (HCBS) to address healthcare access for seniors, and for adults and children living with disabilities, medical complexities, or serious illness. Funding is needed to address waitlists and staffing issues across the HCBS care continuum, including Home and Community Care Block Grant (HCCBG); Program for All-Inclusive Care for the Elderly (PACE); and Medicaid State Plan Personal Care Services (PCS) and Private Duty Nursing (PDN) and Waivers Community Alternatives Program for Disabled Adults (CAP-DA), Community Alternatives Program for Children (CAP-C), and Innovation Services.

Protect Vulnerable Individuals & Families

Increase Funding for Adult Protective Services

Support an increase in recurring funding for Adult Protective Services (APS). This allocation of funds will add much-needed staff, in keeping with the growth of the older adult population and the rise in abuse complaints. Currently, the federal government provides 21% of the funding for APS through the Social Services Block Grant (SSBG). The counties pay 79%. Our state allocates no funding for this increasingly important service. With the growth in the older adult population, APS staff and county Departments of Social Services are greatly challenged by increased demand. Reports have increased 129% in 15 years.

Reform the North Carolina Adult Guardianship Statute

Support guardianship protections and prevent unnecessary guardianships, including: ensuring that every person for whom guardianship is sought has a clear understanding of their rights, both before and after guardianship; giving courts effective tools for review and oversight to make sure guardians are fulfilling their responsibilities; using guardianship only as a last resort if no less restrictive alternative is sufficient to support decision-making.

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