By Rose Hoban and Holly West
State lawmakers in both the North Carolina House and Senate voted for final passage of the biennial budget late Wednesday afternoon. The $20.6 billion plan reflects the revenue goals created in the tax reform bill passed last week and cuts $53 million from last year’s budget total.
While the plan makes deep cuts to education, many advocates in the health care world have said that this budget could have been a lot worse for the state’s health care system.
“We think early-childhood education fared well in the budget,” said Michelle Rivest, head of the North Carolina Child Care Coalition. “We’re pleased with the commitment that the conference committee made to young children. NCPre-K actually got additional funding.”
But others reflecting on the budget were not as pleased as Rivest.
Lisa Hazirjian from the N.C. AIDS Action Network expressed concern about losses in funding to the AIDS Drug Assistance Plan.
“It means that there’s a much greater possibility that we’ll go back to ADAP waiting lists,” Hazirjian said.
As in every budget. there are winners and losers, and North Carolina Health News profiles some of the losers here.
LOSER: ADAP
This year’s budget cuts funding for the AIDS Drug Assistance Program by $8 million, which many say will slow the process of getting medications to people who need them.
ADAP provides financial assistance to low-income people for HIV/AIDS medications. To qualify for the program, individuals must have been diagnosed with HIV and have an income at or below 300 percent of the federal poverty level.
Allison Rice, treasurer for the North Carolina AIDS Action Network and member of the Duke AIDS Legal Project, said the legislature bumped up their funding by $14 million last year, which allowed them to work more efficiently.
Because of this year’s cuts, NCAAN communications program coordinator Claire Herman said the program will now go back to the way it was before, with as many as 800 people waiting to get financial assistance to pay for their AIDS medication.
“Since January, we’ve had a program that provided immediate service,” she said. “We don’t want to go back to the wait list.”
The ADAP program is funded by both state and federal dollars, but Rice said the federal government probably won’t be able to make up for the lack of state funding.
“We’re at a time when there’s going to be sequestration cuts on the federal level,” she said. “It isn’t going to be enough.”
The budget also directs the state Department of Health and Human Services to study options for serving ADAP participants through another existing program, possibly through state Medicaid or the federal Health Benefit Exchange.
Rice said this could end up being a cost-saving solution for the state because programs like Medicaid sometimes get drugs at a discounted rate.
“It could be a cost savings, which would enable them to serve more folks,” she said. “I think it would be great if they could do that.”
LOSER: Children’s Developmental Services Agencies
North Carolina currently has a network of 16 Children’s Developmental Services Agencies scattered around the state that provide early-childhood evaluations for kids up to 3 years old who have been flagged as potentially having a developmental delay.
Annually, about 10,000 children a year are able to access testing for developmental disabilities. Some of the children are found not to have problems, but others go on to receive in-home services such as speech or physical therapy from the program.
Federal law mandates the state provide the early-intervention services, and the goal is to move children with newly identified developmental problems seamlessly into the education system once they’re eligible for preschool.
In earlier versions of the budget, the Department of Health and Human Services was instructed to cut 160 of the program’s approximately 800 positions and close four of the 16 centers.
In the final budget, the dollars are reduced by the same $18 million over two years but DHHS leaders will have some flexibility to decide where to make the cuts around the state.
Budget language also instructs the department to retain the Children’s Developmental Services Agency in Morganton and to prioritize centers with the highest caseloads in rural and underserved areas of the state.
“The justification is that over the past several years, the CDSAs have reverted money at the end of the year,” said Rob Thompson, head of the Covenant With North Carolina’s Children, an advocacy organization. “So that’s the justification that legislators are using to making this reduction.”
Pediatrician Ginny Schreiner worked at the Raleigh CDSA until early May, and she said her position has not been filled, nor have many other positions she saw vacated over the past few years of her employment there.
“Now service coordinators have caseloads where they’ve gone from managing 25 to 40 children,” she said. “Their ability to monitor children’s development and meet the needs of the families … it’s impossible. There’s just not enough hours in the day.”
Both Schreiner and Thompson said they weren’t sure why the agencies were not using their entire appropriation.
A request to speak with state health director Laura Gerald about the agencies’ budgets was declined by DHHS.
LOSER: Tobacco Cessation and Prevention funding
Three years ago, North Carolina had a national model program for reducing teen tobacco use in the form of Tobacco. Reality. Unfiltered. The program was showing results, as surveys indicated that only 15.5 percent of high school students and 4.2 percent of middle schoolers were smoking – the lowest rate since the state started keeping track.
But last year, the legislature reduced the $17.3 million in funding for T.R.U. and the Tobacco Quitline down to $2.7 million, essentially eliminating T.R.U. Lawmakers also wrote a special provision into the budget forbidding the programs that remained from creating any statewide tobacco-cessation programs.
This year, that number has been cut even more, down to $1.2 million, eliminating funding for the You Quit, Two Quit initiative – part of the Quitline – that helped pregnant women stop smoking.
North Carolina received about $137 million in funding this year from the tobacco Master Settlement Agreement (MSA) that was reached with tobacco companies in 1999.
“We’ve seen numbers dropping in terms of smoking out there; they’ve been heading in the right direction. So I think we’re in good shape,” said Rep. Nelson Dollar (R-Cary) in an interview with North Caroline Health News earlier this year.
Tobacco-cessation advocates expressed dismay.
“Lawmakers say the budget is out of control because of Medicaid, and that they’ve had to make all these cuts, and yet we don’t put our efforts into preventing chronic disease,” said Betsy Vetter, director of government relations for the state’s American Heart Association chapter.
“We took a successful program in tobacco-use prevention and now there’s not money for it. Yet in the big picture, preventing chronic disease is the way to go.”
The Centers for Disease Control and Prevention recommends that North Carolina spend $106 million a year in tobacco cessation and prevention.
“We get all that money from the MSA,” Vetter said, “yet when the money comes here, we don’t use any of it on tobacco prevention or cessation.”
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