What's Happening in Washington and What It Means for Our Community

What’s Happening in Washington and What It Means for Our Community

September 30th, 2026

By Kerri Erb, Chief Program and Policy Officer

Fall is bringing a wave of federal activity that will shape services and support for autistic people and their families for years to come. Here’s what the Autism Society of North Carolina is monitoring.

Medicaid work requirements are coming

Starting January 1, 2027, most adults ages 19–64 with Medicaid coverage through expansion will need to document at least 80 hours a month of work, school, or community engagement to keep their benefits. The law does exempt people with disabilities, but that exemption isn’t automatic. People will have to prove they qualify, and the process for doing so is still being finalized.

We’re concerned about the potential impact for autistic adults who don’t carry another Medicaid designation tied to their diagnosis. They may end up navigating extra paperwork to prove they’re exempt from a requirement that was never meant to apply to them in the first place. We’re pushing for a process that recognizes autism diagnoses without adding unnecessary barriers, and we’ll keep you posted as North Carolina finalizes the details. Information will be current and updated here: https://medicaid.ncdhhs.gov/beneficiaries/medicaid-is-changing.

New federal guidance on ABA therapy

In August, federal officials released new guidance for states on overseeing Applied Behavior Analysis (ABA) services in Medicaid, aimed at addressing fraud and inconsistent billing. It does not create new federal requirements, and it does not discourage states from covering ABA. For North Carolina families, the practical effect should be limited as our state’s recent policy changes already go as far as, or further than, what this guidance describes.

A possible new path off the waiting list

A new type of Medicaid waiver, created under recent federal law, could eventually let states serve people with home- and community-based service needs before they reach the level of need typically required for programs like NC Innovations. It’s very early, states can’t apply until 2028 , but it’s a development worth watching, especially for the thousands of North Carolinians currently on the Innovations waitlist.

A shift in community living rights oversight

In 2012, North Carolina settled a lawsuit with the U.S. Department of Justice (DOJ) over how the state was serving adults with serious and persistent mental illness, many of whom were being housed in institutional adult care homes rather than supported to live in their own communities. The settlement, grounded in the Supreme Court’s landmark Olmstead decision, required the state to build out community-based housing, treatment, and employment supports, and by the state’s own count, more than 4,150 people are now in stable, community-integrated housing as a result.

This September, North Carolina and the DOJ jointly asked a federal court to end oversight of the settlement, citing the state’s progress. A judge granted that request, closing out one of the longest-running federal disability rights interventions in North Carolina’s history. Both parties told the court North Carolina had substantially complied with the agreement, and DHHS has said its commitment to community living doesn’t depend on a court order.

The request came just months after the current DOJ rescinded long-standing guidance on how it interprets Olmstead, guidance that has shaped enforcement of the rights of people with mental illness and developmental disabilities nationwide. We look forward to working with state leaders to sustain this progress and strengthen community living options for North Carolinians with disabilities.

Also on our radar

We’re keeping an eye on a few other threads without major news yet: a proposed change to how home care workers are classified under federal wage law, which could affect direct care workforce pay; and delays in enforcement of parts of the federal Home and Community Based Services (HBCS) Access Rule, which sets standards for HSBS services. There is a growing voice around creating a formal designation for “profound autism,” which would have downstream effects on services and supports as well.

Your voice matters here at home, too.

These federal developments, alongside what’s happening at the state level, will shape the Autism Society of North Carolina’s advocacy priorities heading into the 2027 legislative long session. Watch for our Public Policy Priorities Survey this month. We want to hear from autistic individuals, family members, and supporters about what matters most to you.

Comments are closed.