Lawmakers debated into the evening, passing the final $21.73 billion after midnight Thursday evening. Photo credit: Rose Hoban

The real debate over health care issues comes next week, when Medicaid reform will be debated.

By Rose Hoban

A state $21.73 billion budget is on its way to Gov. Pat McCrory’s desk Friday after two bipartisan votes in the House of Representatives on Thursday evening.

In a bill that was close to three months overdue, lawmakers finally found common ground on a spending plan that differed greatly between the two chambers of the legislature.

Lawmakers debated into the evening, passing the final $21.73 billion after midnight Thursday evening. Photo credit: Rose Hoban
Lawmakers debated into the evening, passing the final $21.73 billion after midnight Thursday evening. Photo credit: Rose Hoban

“I’ve never seen two budgets further apart,” said lead budget negotiator Rep. Nelson Dollar (R-Cary) in his introduction to the plan on the House floor. “This was a challenge, but … i can report to you of the principles of this House that are in this conference report.”

Many members of both parties spoke of how they were pleased budget negotiators had wrestled as long as they had in order to wring concessions from the Senate on key pieces of legislation, including child care subsidies, medical examiners and improvements to the foster care system.

While most of the debate centered around the new tax plan, teacher salaries and transportation, health care took a back seat this year. That differs from previous years when lawmakers wrestled with growing costs of Medicaid, mental health and the state employees health plan.

Health care issues did get some attention during the debate, in particular when Rep. Carla Cunningham (D-Charlotte) drew attention to the mental health budget.

Cunningham took issue with cuts to mental health local management entities, several of whom have amassed large cash balances. The budget claws back some of that money in the form of cuts to funding totaling $260 million over the biennium.

“Some years ago, we told the LMEs of their allocation that if they had funds left over, they could keep these funds and use them for new programs or other related issues,” Cunningham said. “So these LMEs moved forward with that understanding from the state.”

“I don’t think that sets a good tone for our state. After we’ve led these LMEs to believe that you could keep this money, now we’re going to come back and say, ‘Oh, no, no, no; we’re going to punish you for doing that.’”

Rep. Marilyn Avila (R-Raleigh) pointed out that the budget does spend money on the mental health system, in particular on funding for community programs.

“We’ve been struggling for a number of years to make up for the shortcoming of community services that were not there when we sent mental health patients back into our community,” she said.

Avila talked about a Wake County pilot program for training paramedics to identify patients in mental health crisis and redirect them to mental health crisis centers instead of to emergency rooms. The budget extends this pilot program to three more counties over the biennium.

“It cuts down on the expense regarding emergency rooms, but it also guarantees that people get quickly the right care that they need,” she said, also noting that the budget provides funding for a real-time registry of psychiatric beds for people in mental health crisis.

Other mental health initiatives in the budget:

  • additional psychiatric beds in rural and community hospitals;
  • the establishment of a traumatic brain injury program paid for by Medicaid;
  • and the creation of a crisis support team for children and adolescents with intellectual and developmental disabilities.

Rep. Jean Farmer-Butterfield (D-Wilson) praised dollars being earmarked for psychiatric services in the state’s prisons, but she pointed out that there still need to be better community-based resources for people with mental health problems.

“How do we avoid jails and prisons serving these individual versus providing treatment and services in the community,” she said, pointing out that 12 percent of the jail and prison population in the state has a mental illness. “So we’re saying that people with chronic mental illness need to go to prison to receive services.

“Why not do prevention and jail-diversion programs more in North Carolina. They work.”

Other expenditures in the budget include:

  • providing support for the Office of the Chief Medical Examiner, computerizing the death records system and providing revenue in the form of increased fees for autopsies;
  • provides money for increasing the age of foster care to 21 and extra supports for kids aging out of the foster care system;
  • and restores the tax deduction for medical expenses.

But among the things missing from the state budget are funding for tobacco-cessation programs, the corner store initiative and the ABLE Act, which allows families of children with disabilities to save for their future.

The final budget passed on a bipartisan vote of 81-33 and will be go to the governor just in time. The General Assembly’s temporary resolution allowing for the continued operations of state government runs out at midnight Friday.

You can get more details on the Health and Human Services budget on N.C. Health News’ final budget comparison table, available here.

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