Health Care Advocates Anxiously Await Details of Medicaid Budget or Cuts
After weeks of delay on a budget proposal in the North Carolina General Assembly, legislative leaders held a press conference Tuesday to discuss a “budget framework” that had been worked out between the House and Senate.
By Hyun Namkoong
After two long months of negotiating and haggling over lottery numbers, Medicaid and teacher pay, Speaker of the House Thom Tillis and Senate President Pro Tempore Phil Berger came together Tuesday to present a compromised “budget framework.”
Though Tillis and Berger discussed major points of the budget – including a 7 percent raise for teachers, preservation of current Medicaid eligibility and a 1 percent cut to Medicaid provider rates – specific details of the budget have yet to be released on Jones Street.
Much to the relief of disability advocates, Medicaid eligibility requirements for those who are classified as “medically needy” will remain intact. Proposed changes for Medicaid eligibility requirements in the Senate version of the budget had caused organizations such as The Arc of North Carolina that work with individuals with disabilities to worry over budget proposals.
“We are very happy that the House leadership and the Senate leadership have agreed to not adjust any of the Medicaid eligibility,” said Julia Adams, assistant director of government relations for The Arc.
While Senate and House leaders were quick to point out the increase in teacher pay and a $1,000 pay raise for most state employees, they were less willing to discuss cuts from the budget.
When asked what kind of reductions were made in Medicaid services, Rep. Nelson Dollar (R-Cary), chair of the House Appropriations Committee for Health and Human Services, was unable to give an answer other than a 1 percent reduction in Medicaid provider rates.
“While we’re pleased that they did not cut [Medicaid] eligibility, we are concerned about the cumulative impact of rate cuts,” said Greg Griggs, executive vice president of the N.C. Academy of Family Physicians. “This apparently is in addition to the 3 percent shared savings that is being converted into a rate cut.”
Last year’s budget called for Medicaid providers to take a 3 percent cut in exchange for participating in a “shared savings” program, in which they could earn back those dollars by becoming more efficient. Earlier versions of this year’s budget retained the rate cut while eliminating the shared savings program, which was never implemented.
No details yet
The delay on details of the compromised budget has advocates and physicians hesitant to say how the budget will affect their clients or health care in the state.
“We have not seen the final product, obviously,” Adams said. “We look forward to reading the whole budget and doing a full analysis.”
“We haven’t seen any details of the budget,” Griggs said when asked about how the budget might affect physicians.
Medicaid reform TBD
A compromise on how to reform Medicaid has yet to be reached.
After months of work over the past year, a blue ribbon panel created a Medicaid reform plan that would move the state’s providers to forming accountable care organizations that would share financial rewards for efficiencies and bear more risk for increased expenditures.
But in their budget, senators want to scrap that plan to move more quickly to a plan that includes for-profit managed care companies.
There was uneasy laughter from the House and Senate leaders when asked if Medicaid reform was in the budget. Dollar shook his head vigorously when asked about the Senate proposal for Medicaid reform, indicating the wide divide that has yet to be bridged between the House and Senate on Medicaid reform.
“The Senate has passed a reform proposal that is different from the House proposal,” Berger said. “We are hopeful something will get worked out.”
In a press conference held earlier in the day by Rep. Larry Hall (D-Durham), leader of the House Democrats, it was clear that Democrats were upset that they were largely excluded from budget negotiations.
“Nobody knows what’s in the budget,” Hall said. “It might be a mystery. I’m sure you want to know what is in the budget.”
He and other Democrats complained that the final process was an undemocratic, closed-doors approach.
The budget is presented as a conference report, meaning that lawmakers will only have the opportunity for an up-or-down vote without being able to propose amendments to the bill.
“What we see is what we get,” said Rep. Susan Fisher (D-Asheville), House Minority Whip.
“And they’ll ram that through both chambers, and that’s what they’re going to do before the public even knows what is in the bill,” she said.