New General Assembly budget includes many health care features, but no Medicaid expansion

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By Rose Hoban

After several weeks of negotiations between the North Carolina Senate and the House of Representatives, the two chambers came together Tuesday to present a compromise budget they’ll be sending to Gov. Roy Cooper for his signature.

But it’s likely Cooper will be vetoing it. For months, the governor has signaled that he would veto any state spending plan which does not contain provisions to expand the Medicaid program to cover hundreds of thousands of additional low-income workers who would become eligible under expansion.

That likelihood loomed large over Tuesday’s press conference, where Republican leaders of the House and the Senate stood together and criticized Cooper for not negotiating with them around the $24 billion spending plan.

“We’ve been asking the governor for weeks to share his specific compromise proposals with us,   Up to this point, he has not done so,” said Senate leader Phil Berger (R-Eden). “Last week, the governor said in a press statement that we should negotiate the budget immediately to avoid a drawn out process, he was in New York when we tried to contact him.”

“The governor has not provided us with any specific proposal beyond general philosophical opposition to a few of the major items that we include in this budget and his desire to expand Medicaid,” said Berger, who stood before two large displays listing legislative spending amounts in one column and another column labeled “Governor’s Counter Proposal” with “Not Provided” in the spaces where budget numbers would be.

Berger and House Speaker Tim Moore said they hoped Cooper would sign their budget and allow the legislature to adjourn.

Language in the budget “encourages the Governor to convene an extra session… The purpose of the extra session would be to consider access to health care across North Carolina, including issues pertaining to health insurance, association health plans, Medicaid, and Medicaid expansion.” But the two leaders said there was no guarantee such a session would result in an expansion plan.

“This is a great budget that I’m hopeful that when Governor Cooper receives it from us, he’ll reconsider his position and he will sign this budget,” said House Speaker Tim Moore (R-Kings Mountain).

Heavy lifting ahead for Medicaid

When asked whether he had confidence that a special session on Medicaid expansion would yield any movement on the issue, budget chair Donny Lambeth (R-Winston-Salem) said there is still more to fix in Medicaid.

Lambeth is one of four Republican sponsors of a bill that would expand Medicaid, along with adding a work requirement and a requirement that beneficiaries participate in wellness activities.

Rep. Donny Lambeth (R-Winston-Salem) discussed some of the structural issues with Medicaid that the legislature has addressed over the past few years during a press conference at the NC General Assembly on Tuesday. Photo credit: Emily Davis

“I was actually recruited to come down here and work on Medicaid … we’re not there yet,” said Lambeth, who is a retired hospital president. “We have to fix our current system. We had significant overruns, we’ve stabilized that.”

He went on to talk about the “heavy lift” of transforming the program from its current fee-for-service payment structure to one that’s run by managed care companies that are given lump-sum payments to provide all the care an individual beneficiary might need. Two regions in the state are slated to start making the shift in November.

“We’re not there yet,” Lambeth told the assembled press corps. “Let’s get that done … I can’t oversell you on how difficult that’s going to be.”

But in an interview after the press conference, he expressed frustration that his North Carolina Health Care for Working Families bill had not gained any traction.

“I do believe that if I’m allowed with my other co-sponsors, remember, there’s a doctor, there’s a nurse, and there’s a chairman of our health committee, these are not liberal individuals who just came up with this notion we have put a lot of thought in this and we can answer every question about we’ve heard that was a concern,” he said. “ So it’s really been a frustration to all four of us that we’ve not been allowed to have this conversation in our caucus.”

He said that he’d had countless conversations with members of both chambers and said that in the House, at least, there likely were the votes to get it through that chamber.

And he said he’s had conversations with members of the Senate to counter what he labeled “misinformation.”

“And when they asked me questions, I’m like, no, that’s not right. Do you not understand that North Carolinians are currently funding [expansion in other states] through about 30 taxes that were implemented?’” he said. “And when I go through those kind of details, they’re like, ‘No, I did not know that.’”

Other budget features

The $5.57 billion health and human services portion of the legislative proposal also includes:

  • Creating a new tax to be levied on the managed care companies that will be running the state’s Medicaid program starting next year, and creates new hospital assessments to replace the current assessment system, which partially funds the state’s portion of the Medicaid program,
  • Funding 1,000 slots on a Medicaid-funded program that allows adults with intellectual and developmental disabilities to live more fully in their home communities. Currently, the program has a 12,000 person waiting list,
  • Increasing the personal needs allowance to $70 a month for people living in adult care and group homes, effective in October,
  • Calls for moving the Department of Health and Human Services to Granville County, setting aside a total of $71 million over the biennium to initiate the process,
  • Adds $3.5 million in loan repayment for health care providers willing to spend time practicing in rural areas,
  • Makes policy changes and funding increases to the child welfare system,
  • Increases reimbursement to foster and adoptive families starting in 2020,
  • Calls for a firearm safety and storage initiative that would cost $160,000 over the coming two years,
  • Grants a total of $2.64M, to so-called “crisis pregnancy centers,” including individual grants ranging from $15,000 to $100,000 to nine such facilities located around the state.

In addition, the health and human services spending plan includes pages of small special projects, targeting food pantries, shelters, clinics and mostly Christian-based substance abuse treatment programs. These earmarks, often called “pork-barrel spending,” are often crafted to help lawmakers show their constituents that they can “bring home the bacon.”

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