The Senate budget proposal upends the state Department of Health and Human Services by moving to take away its biggest responsibility, Medicaid. At the same time it would cut thousands of elderly and disabled people, and other beneficiaries with high medical bills, from the government insurance plan.
This appears to be a first step Senate Republicans are proposing to cut Medicaid services and shrink the number of beneficiaries.
The budget includes a provision that would have the state health agency develop proposals by next year for cutting optional Medicaid services for elderly and disabled beneficiaries, limiting coverage to only that required by federal regulations or laws.
North Carolina’s Medicaid program is considered “rich” because it goes far beyond the basics. “Optional” services under Medicaid include prescription drugs, mental health and dental care.
The possibility that some elderly and disabled people would be kicked off the Medicaid rolls has the long-term care industry mobilizing to fight it, saying the reduction would threaten the ability of some facilities to stay open.
Residents of The Covington, an assisted living facility in Raleigh, and their family members worry whether proposed Medicaid budget cuts will force them out of what they see as their only safe option for care.
“We’ve got a damn bunch of ignorant people in the state legislature,” said Chester Broadway, 73, who had his leg amputated as a result of an infection and uses a wheelchair. He moved into The Covington about a year ago.
“If they were in this position, they wouldn’t be doing it,” he said.
Tension over DHHS
The tension between the executive branch and Senate Republicans is reflected in the different approaches to DHHS. The state budget office and legislative financial experts could not agree on how much Medicaid would cost next year, and Senate Republicans say Gov. Pat McCrory’s budget seriously low-balled next year’s Medicaid budget.
That has the Senate budget spending more on Medicaid next year than McCrory’s budget would but still dropping categories of people from the insurance plan, something McCrory did not do.
Medicaid is a $13 billion state and federal insurance program that covers low-income children and their parents, and the aged, blind and disabled. About 1.8 million residents are enrolled. The state picks up about a third of the costs, and the federal government pays the rest.
Lou Wilson, lobbyist for the N.C. Association, Long Term Care Facilities, told Sen. Ralph Hise, a Spruce Pine Republican who steers health budget writing, that some would not be able to stay open if the proposed cuts go through.
Hise disagreed. Under the provision, elderly people who qualify for a benefit called State/County Special Assistance would no longer automatically qualify for Medicaid. The Senate’s budget document says nearly 12,000 people would be dropped from the program. But Hise, citing DHHS staff, said only about 5,200 to 5,300 aged, blind and disabled people would be cut from the insurance program. People have other options for health insurance, he said, including the health insurance exchange established under the federal Affordable Care Act. The exchange would also be an option for the 3,342 medically needy people the budget cuts from Medicaid, he said.
The Medically Needy program enrolls people who have high medical expenses but whose incomes otherwise would make them ineligible for the insurance.
Among residents at The Covington are Medicaid beneficiaries with adult children who work full-time jobs and cannot stay home to make sure their parents don’t wander off, forget to take their medication, or accidentally start fires.
Anne Keyworth, 25, is a student. Her two sisters, 21 and 28, work “more than full-time” and cannot be home to watch their father, Rick.
The sisters would not be able to afford their dad’s care on their own, she said. Not only would The Covington be out of reach, but without Medicaid, they’d have to find the money to cover $3,000 a month in prescriptions.
“This just sends a bad message that the legislators don’t care about the elderly and their access to health care,” Keyworth said. “I have more faith in North Carolina than that.”
Tired of missteps
Republican leaders of the Senate budget committee said they were tired of missteps in the state DHHS that forced the legislature year after year to scramble to cover budget holes. Senate leaders are dissatisfied with plans for Medicaid service and funding changes that McCrory and DHHS Secretary Aldona Wos have promoted this year.
The new agency the Senate proposes to set up would take over for future Medicaid planning.
Asked to address the issue of moving Medicaid from DHHS, an agency spokesman issued a statement about how it was prepared to work with the legislature on the Medicaid reform plan.
The Senate envisions a much different Medicaid program than DHHS developed.
The Senate wants a plan that will lead to predictable Medicaid budgets, which Hise said the DHHS plan does not provide. The legislature asked DHHS to come up with a plan for integrated “whole-person” care that would make sure that mental health, physical health and other patient needs were addressed.
Hise said DHHS did not deliver.
“Clearly, they carved out mental health, they carved out long-term care, and they come up with some interesting formulas for carving out pharmaceuticals,” he said. “We cannot continue to segment individuals’ care.”