House lawmakers come back for one more budget vote and are likely to wrap up work for the year Friday or Saturday.
House lawmakers come back for one more budget vote and are likely to wrap up work for the year Friday or Saturday. Photo credit: Rose Hoban

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<p>Close to three months late, the state budget is finally here.

By Rose Hoban

Members of the health care community who have been waiting for months, actually years, for a final deal on the long-anticipated overhaul of North Carolina’s Medicaid program will have to wait a few days longer.

That’s because language on Medicaid reform is not in the final state budget, but in a separate bill that will be made public later this week or early next.

House Speaker Tim Moore (R-Kings Mountain, striped tie) chats with Rep. Pat McElraft (R-Emerald Isle) after a press conference to introduce the state budget. Behind Moore are Senate Majority Leader Harry Brown (R-Jacksonville), left, and Senate President Pro Tempore Phil Berger (R-Eden), right. Photo credit: Rose Hoban

“The actual language of the bill has really been agreed to at this point,” House Speaker Tim Moore (R-Kings Mountain) told reporters at a Monday afternoon press conference held to give a broad outline of the $21.7 billion budget document, which had not yet been made public.

Senate President Pro Tempore Phil Berger (R-Eden) explained that there are three additional bills tied to the budget document that have yet to be made public. These bills detail Gov. Pat McCrory’s bond package, economic development and Medicaid.

“One of the complicated issues was that we had extra money that we haven’t had in the past,” said Berger when asked what led to the nearly three-month delay in release of the budget. “The reality is that we’ve talked about Medicaid reform for years.”

“We’re concerned about the length of time,” Berger said, “but the more important thing is that we get it right.”

Berger and Moore said the budget document adds $225 million to finance the restructuring of Medicaid, but did not elaborate on what the allocation would cover.

Early budget reactions

Rep. Tricia Cotham (D-Matthews), who was a member of the conference committee, said members of the minority didn’t have input in the process, although they were informed once deals were struck.

“However, it is 500 pages, so it’s very hard to know exactly what’s in it. Until that, its hard to have an opinion,” she said.

Cotham lauded some of the health and human services provisions, including behavioral health training for paramedics, extending the age in which to be eligible to remain in foster care to 21 and additional beds for mental health patients.

“I’ve been around long enough, and been here through many budget cycles, to know you really want to look at the details, the special provisions, the new policies that are in there before you commit to anything,” she said. “There were, of course, some good things that were said, but that’s how you do a sales pitch.”

While lobbyists and advocates in the legislative building were still waiting for the final budget document, many had an indication of how their issues will fare.

North Carolina Hospital Association lobbyist Cody Hand said he was pleased that not-for-profit hospitals would retain their sales tax exemptions, which for organizations such as Charlotte-based Carolinas Healthcare System can be worth upwards of $40 million.

But Hand also said teaching hospitals would lose a total of $40 million with the elimination of a reimbursement for the use of medical residents. A smaller hospital, like Cape Fear Valley Medical Center, will lose $300,000, whereas UNC Hospitals in Chapel Hill will lose a whopping $14.5 million in income, and Vidant Medical Center, which is affiliated with East Carolina University’s medical school, will lose $5.5 million.

Sam Taylor, lobbyist for NC BIO, said he was concerned about the research-and-development tax credit for biotechnology start-up companies that’s been in the state budget for the past few years, but which did not earn a mention during the press conference.

Berger and Moore said the budget deal would include a $750 bonus for all state employees, boost incomes for new teachers, fund driver’s education for the upcoming biennium while studying its effectiveness and not alter the state’s certificate of need regimen for allocating medical resources.

Fast track

Despite the fact that the document was not yet public Monday evening, Berger said he’s planning for a first vote on the bill Tuesday morning and through his chamber by Wednesday.

Senate Democratic leader Dan Blue (D-Raleigh) said in a press release that the closed-door budget process was a “disgrace.”

“Legislators and the public alike will have less than 24 hours to read and digest a final budget that is expected to be well over 500 pages,” Blue wrote.

Moore said his plan is to debate the budget in the House on Thursday for a preliminary vote and stay late for a final vote after midnight Friday morning.

Cotham said she was disappointed. “Of course, we’ll be voting in the middle of the night, which is never a good thing,” she said.

Berger and Moore said they anticipate the bill will be passed and signed by the time the continuing resolution for state spending runs out on Friday.

Health care changes in the budget (preliminary):

  • Restores tax deduction for medical expenses for all ages, not just seniors
  • Fully funds driver’s education
  • Increases support for the medical school at East Carolina University by $8 million a year
  • Provides funding for rural medical residencies in the Mountain Area Health Education Center, with $8 million a year
  • Does not eliminate Community Care of North Carolina
  • Increases support for community mental health services:
    • 7 percent increase for psychiatric beds in local hospitals
    • Adds dozens of mental health beds at Central Prison
    • Establishes mental health treatment units in eight prisons
    • Creates a Medicaid waiver for traumatic brain injury patients
    • Creates training for EMTs for diversion from emergency departments for people in mental health crisis
  • Raises age for foster children to 21 years old, adds funding for extra foster care caseload.
  • Restores cuts to seniors in the Home and Community Care Block Grant
  • Provides funds for State Medical Examiner system upgrades
  • $38 million in funding to adjust salaries of hard to recruit employees (such as nurses for state hospitals)
  • $186 million for Medicaid contingency fund
  • $225 million over two years to be used

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