Budget Part 2: Small Changes, Big Effects
Medicaid is the state’s biggest program in health and human services. But many other small programs with large impacts receive appropriations from the state. Here’s a roundup of how those programs fared in the state budget.
By Rose Hoban
Budget writers make small adjustments to programs throughout the state budget plan, and often, small changes in language can have a big effect.
One small, but significant change in this year’s budget makes a change to Medicaid in how recipients’ income can push them out of the Medicaid program.
Often, people receiving Medicaid might also receive other payments from Social Security or from a pension. When those people receive annual cost of living adjustments, their income can be pushed over the income limit for Medicaid, sometimes by only a handful of dollars.
A new provision in the budget allows for the Medicaid program to disregard cost-of-living allowances given to recipients when calculating eligibility for receiving Medicaid benefits.
“It’s one of those things that people need but it obligates the state for future payments that we still don’t have a handle on,” said Rep. Marilyn Avila (R-Raleigh), who sits on the Health and Human Services subcommittee, and helped push the measure.
“It’s good because people need it. But I think in terms of future budgets that we really do need to take a look at where we’re headed with our promises to our people and make sure that at some point in the future we’re not going to have to pull the rug out from under them,” Avila said.
The funding picture was positive for a number of small programs, all of which had been included in the House budget but had been cut out of the Senate budget:
Medication Assistance Program: to help uninsured patients get access to medications: maintained at $1.7 million
CheckMeds: provides funds for pharmacists to counsel patients on the correct use of their prescriptions: maintained at $1.6 million
Drug Treatment Courts: judicial programs to reduce the number of drug offenders in jail, giving them opportunities for rehabilitation: cut by $2.26 million
Maternity Homes: residential programs for teens and young women who are pregnant: maintained at $375,000
ECU High Risk Maternity Clinic: a clinic serving women in 29 Eastern NC counties at risk for preterm birth: maintained at $375,000
Services for rape victims: the money replaces lost federal funding: maintained at $197,000
17-P: a program to provide pregnant women on Medicaid at risk for preterm birth with the medication 17-Progesterone
Small programs, big cuts
A number of small programs saw significant cuts, some of which could cause the programs to fold.
Leaders of the state’s tobacco cessation programs expressed disappointment at the state’s failure to fund programs for the upcoming year.
Last year, the General Assembly dismantled the Health and Wellness Trust Fund, a pool of money funded by North Carolina’s annual share of the tobacco Master Settlement Agreement, signed in 1998.
The HWTF provided annual money for the state’s tobacco cessation programs, also organizations with a mission to reduce infant mortality and to provide the uninsured with medications.
Last year, remnants of the HWTF funneled about $17 million to tobacco cessation programs, including the Quitline, the Tobacco. Reality. Unfiltered. program aimed at youth and a statewide media campaign.
This year’s budget expressly prohibits the use of any state funds to create statewide media campaigns.
“The CDC is still running commercials,” said Rep. Nelson Dollar, referring to the federal Centers for Disease Control and Prevention, “so people will continue to see ads against smoking.”
Advocates expressed frustration.
“Only if not preventing smoking in the first place doesn’t take all your money, then you have money to prevent what caused you to spend all your money in the first place,” said Peg O’Connell, a representative from the North Carolina Alliance for Health. “Even when they’re so terribly worried about the expenditures on Medicaid, for them to cut the kind of prevention program that we know in the long term will save us millions of dollars seems short-sighted.”
“We saved 53,000 kids from starting to smoke over the last eight years. So we know that what we were doing was effective and it worked,” O’Connell said. “Until we started pulling down the Health and Wellness money, there was never any money for tobacco prevention.”
Another program that saw its state funding eliminated is Project CARE, a program to help families caring for a relative with Alzheimer’s disease, which saw a cut $500,000, it’s entire allocation from last year.
“People love that program,” said Verla Insko (D-Chapel Hill) who championed the program during budget debates. “The people who participated in the program were grateful for it.”
Another program defunded in the budget is the Healthy Start Foundation, an organization that provides educational support for clinicians working with pregnant women.
“We have 22 years of infrastructure to support reducing infant mortality in the state, now, we could be gone tomorrow,” said Janice Freedman, the Healthy Start director.
Freedman said the given reason for cutting the program’s $434,000 state allocation was that Healthy Start does not provide direct services.
“We don’t have a clinic or a storefront. We provide the information, the resources to build the capacity of the community agencies to do the work with the women and families they’re seeing,” said Freedman, who also explained that the program also developed and provides an Internet portal for families to sign up for the state children’s health insurance program, Health Choice.
“There’s a lot of what we do that really supports what we do across North Carolina,” she said. “I can’t believe that we were judged and found lacking.”
Loss of the money will also mean loss of about $300,000 in federal matching dollars. Freedman said she would be meeting with her board and staff this week to talk about the program’s future.