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North Carolina is trying to squeeze savings out of Medicaid, even as more people than anticipated sign up for coverage under the government health care program for the poor.
So far, the cuts primarily mean that doctors, hospitals and providers are being paid less for their services, but state officials and others warn that cuts to medical services and significant job losses in health care could be looming.
Cuts ordered by the legislature this year mean that Medicaid, which is funded jointly by federal and state government, will lose $1.5 billion this year.
Those cuts have touched nearly all areas of health care. Doctors and hospitals are being paid less to treat Medicaid patients, and the state is spending less on community mental health and personal care services for the elderly.
Meanwhile, more people are asking for help. About 8,000 more people than anticipated were signed up for the government insurance program in August than legislators budgeted for, and September enrollment was 3,000 people higher than anticipated.
Unless there's a dramatic economic turnaround in the next year, the budget pressure could increase, said Lanier Cansler, head of the state Department of Health and Human Services, which oversees Medicaid.
The state is expected to get $440 million less next year from the federal government to fill Medicaid budget holes, he said, which may mean legislators will have to consider cutting medical services.
"We're at the point to where we're not going to be able to keep access in place if we reduce the budget substantially more," Cansler said Tuesday.
Department administrators also worry that some doctors may decide to stop treating Medicaid patients.
"We've got a tremendous challenge this year," Cansler said. "The challenge will just be multiple next year,"
This year, most of the state's Medicaid 1.4 million recipients - those who use the insurance for routine health care - won't feel the pinch, Cansler said.
But doctors, hospitals and health agencies that care for them will get less money to do so, and paid caregivers will be watched more closely as the state tries to contain costs by making sure patients don't get treatments they don't need.
Hospitals, mental health providers, and home health agencies anticipate thousands of job losses as a result of rate reductions and program constraints.
