The budget will include additional dollars for Medicaid, no compensation for eugenics victims and deep cuts to prevention programs.
By Rose Hoban
House and Senate negotiators at the General Assembly announced an agreement Wednesday morning for a $20.2 billion overall state budget for the upcoming fiscal year.
A discussion of the problems with Medicaid dominated a large portion of the press conference legislative leaders held to announce the budget deal.
Senate leader Phil Berger (R-Winston-Salem) told reporters the budget sets aside $100 million for a Medicaid rainy day fund.
Medicaid was the topic of repeated committee hearings over the past year as the program developed a funding gap that grew steadily over the winter to at least $150 million.
For example, Rep. Nelson Dollar (R-Cary) said more children entered the Medicaid program than expected this winter, driving up costs.
According to Dollar, re-calculations to the base Medicaid budget in recent months have bumped that number up to $212 million. He criticized the program’s planners who he said failed to anticipate the demand for services.
Dollar also said it’s possible the final tab for Medicaid will be even more by the time the last payment checks for this fiscal year are cut at the end of June.
“It’s hard for us to trust, every time we hear a number from the department, it seems to be changing, so we would like to get some certainty in these areas,” Dollar said.
Sen. Pete Brunstetter (R-Lewisville) said a bill to provide extra dollars for Medicaid will make it’s way through both houses of the legislature over the coming week.
There are no service or rate reductions to the Medicaid budget for this year.
“But, you will see, as long as Medicaid overruns continue to eat our availability, that’s going to impact our ability to redirect dollars to education and into the environment and transportation and other areas where we need it,” Brunstetter said.
According to Dollar, the budget includes only $2.7 million for tobacco cessation programs in the form of a block grant, most of that money would go towards the tobacco Quitline.
When asked about funds for a anti-smoking media campaign, Dollar responded that there would still be commercials on television from the Centers for Disease Control and Prevention.
North Carolina currently has the lowest youth smoking rate in state history, with only 15.5 percent of teens starting to smoke, down from 43 percent in 2003.
“I’m disappointed that the state appears to be abandoning the different programs that have helped us make a dent in youth smoking over the past decade,” said Rob Thompson, head of the Covenant with North Carolina’s Children, a coalition of children’s advocacy organizations.
Money is also in the budget to begin to resolve issues with the U.S. Department of Justice over the North Carolina’s use of adult care homes to house people with mental health issues. The final tally to begin to unwind problems with adult care homes comes to $50 million in this budget, the same amount asked for in the House budget. The money including $10.3 million to create new housing opportunities for some people with mental health problems, and more than $27 million to help adult care homes make the transition from housing people with mental health problems.
House and Senate leaders are caucusing with their members this afternoon to put the final touches on the budget. Word is that the full budget will be released after the meetings, late this afternoon.
An obvious reform is to block grant Medicaid funds to the states. This would grant them greater flexibility in tailoring Medicaid offerings to their state’s specific needs, and would place the onus upon the states to limit spending.
Block grants would encourage states to mimic successful private health care delivery reforms, and if those reforms reduce spending on acute care by just 4% per year, annual spending would fall by $9.5 billion (http://bit.ly/MhHbk8).
Block grants would remove a significant incentive for states to inflate the price of health care by imposing health care taxes that increase federal matching funds
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