Part 1 of 2: Eugenics and Mental Health: House and Senate leaders announced a deal on their concurrence budget Wednesday morning. Medicaid was the big item in the budget. Absent was funding for compensating eugenics victims. Mental Health funding stays about the same, even as the system sees big changes.
By Rose Hoban
Correction: the story has been changed to reflect accurate amounts designated for helping adult care homes transition. The correct number is $39.7 million.
Leaders from the General Assembly released their final concurrence budget late Wednesday afternoon, a bill that calls for close to $4.7 billion in health care related appropriations, about $71 million more than what House budget writers had asked for.
The increased total is not a reflection of growth in health care services, however. The tally includes dollars to close a Medicaid gap of more than $212 million, up from an anticipated $150 million. The total also includes program funds that will only be made available after January 1, 2013, and only if Medicaid has no shortfall at that time.
“Unfortunately in many respects, it’s an entitlement program, it’s driven a lot of our budget,” said Rep. Nelson Dollar (R-Cary), who chairs the Health and Human Services appropriations committee, referring to Medicaid. “We are working on programs to reform Medicaid, we are working on turning it around. But this is going to take some years to work this out.”
Former House Speaker Joe Hackney (D-Chapel Hill) had a different take on the majority’s approach to Medicaid.
“We told them, Rep. Insko told them on the floor that they had underfunded Medicaid significantly. They continue to underfund it,” Hackney said. “It is, in fairness, a growth program. But remember that they cut it sufficiently to leave a billion dollars of federal money on the table last time,” he said.
Arguably, the most notable omission from the budget is the lack of any money to compensate victims of North Carolina’s long-running eugenics program.
“An apology is fine, but an egregious harm was done to people. Their bodies were invaded,” said Rep Micky Michaux (D-Durham). “And certainly, to a lot of them, $50,000 is not enough, but at least it’s a start, going in the right direction.”
House Speaker Thom Tillis (R-Charlotte) said he took the lack of funding for eugenics victims as a personal failure, and would continue to work on the issue.
“I don’t think all states should follow our lead,” Tillis said, referring to the fact that North Carolina allowed the state’s forced sterilization program to continue long after most other states with programs had terminated theirs. “I don’t think an apology is enough in North Carolina.”
Senate leader Phil Berger (R-Eden) told reporters that several senators had misgivings about the $10 million appropriation to compensate victims.
“We were not able to see that there was support in the senate to go forward with the proposal,” Berger said.
Proponents of compensating victims expressed frustration.
“It just appears cold, right now there’s no explanation, they dodged the issue,” said Mark Bold from Justice for Sterilization Victims Project who represents people sterilized in North Carolina, Virginia and California.
“We have no idea what happened. There was a lot of momentum going forward, and… nothing,” Bold said. He said his organization has attempted to contact Senate leaders without success, and would continue to push the issue.
“Nobody’s heard, the victims have been kept in the loop about what the concerns are, and so it just seems to have died off. We don’t have an explanation,” he said. “The state has missed a historic opportunity.”
Mental health funding
The final budget includes about $50 million to begin to transition people with mental health disabilities who live in adult care homes out of the institutions and into community settings.
About $10.3 million will go toward creating housing options for people with mental health issues to move into alternative housing over the coming year. Leaders in the mental health advocacy community expect that sum will be followed with appropriations in subsequent years to satisfy a U.S. Department of Justice investigation that found North Carolina inappropriately housed people with mental health disabilities in adult care homes across the state.
Another $39.7 million will go to adult care homes to provide them with support as they transition residents with mental health issues out of their facilities. During the transition period, many adult care homes could lose Medicaid funding for those residents, the money is intended to insure the homes are not in immediate jeopardy of closing as they lose the funding that came from those residents.
Rep. Dollar said it could take years to create enough housing for residents of adult care homes, and in the meantime, those people need somewhere to live.
The budget trims $20 million from funds for local mental health agencies to buy community services, a cut that’s $10 million more than what House budget writers had specified.
The budget also allocates fewer dollars to expand contracts to provide psychiatric beds in local, community hospitals. In addition, those funds will only be released in January, 2013, once legislators are convinced Medicaid is staying within its budget.
Another mental health expenditure contingent on Medicaid staying within budget until January is a provision to create 19 extra beds at Broughton Hospital, a state psychiatric facility in Morganton.
Medicaid has experienced budget overruns in most years of the past decade. In addition, lawmakers have included $73 million in savings to the program in the form of savings achieved by changes in pharmacy benefits, reducing fraud and waste, and savings achieved by the state’s medical home program. Democratic leaders have called the savings overly optimistic.