Legislative Building in Raleigh, where the state budget is crafted
Legislative Building in Raleigh, Image courtesy of State Government Relations, UNC


North Carolina’s lawmakers return to Raleigh this week to adjust the budget for the coming fiscal year. We take a look at what health advocates will be working on this session.

By Rose Hoban

Even though the headlines coming out of the legislature are focused on the controversial law known as HB2, health care advocates are focused on getting some of their priorities heard and passed this year.

Last year, the health care discussion at the legislature was dominated by a sharp debate on the shape and scope of a major Medicaid overhaul, the program that provides health care for low-income children, some of their parents, low-income seniors and people with disabilities.

But with the Medicaid reform bill passed, there’s hope that now some other health care issues will receive attention.

Advocates anticipate difficult transit through the Senate, which has been reluctant to act on new appropriations.

Peg O’Connell, a long-time lobbyist who represents public health interests, called the Senate a “tougher climb,” largely because that chamber tends to set lower budget targets.

As of the end of March, the state was running an excess of more than $159 million in general fund revenues, including $57.8 million more in income tax revenues, than at the same time period in 2015.

Total income tax revenue estimates are due at the end of this month, but advocates are hoping there’s some new money that could come to support long-standing needs, including support for people with Alzheimer’s and their caregivers; getting healthy groceries into food deserts; and funding mental health, tobacco-cessation and other public health initiatives.

Top of the list: Mental health

New recommendations from members of the Governor’s Task Force on Mental Health and Substance Use that were made public this winter would focus on reducing opioid overdose, increasing access to mental health courts  and getting more mental health providers into the pipeline.

All of those issues made it into Gov. Pat McCrory’s budget, to the tune of $30 million to enhance case management for people with mental health disabilities and creating more transitional housing. That kind of help is essential, especially for those who are transitioning from either prison or a psychiatric institution back into the community.

A hospital emergency department may be a good place for a heart attack patient, but advocates say it's the wrong setting for someone in psychiatric crisis.
A hospital emergency department may be a good place for a heart attack patient, but advocates say it’s the wrong setting for someone in psychiatric crisis. Photo courtesy CRMF Crumlin, flickr creative commons

“That’s something that I’ve also been advocating for for a while,” said Rep. Jean Farmer-Butterfield (D-Wilson), who works with a not-for-profit organization that provides guardianship services for people who are unable to manage independently. “I know it’s a critical need. People do not know how to use the system; they need someone to coordinate that.”

“We’re certainly going to look at all of those priorities, and other priorities,” said House Appropriations chair Nelson Dollar (R-Cary), but he declined to get more specific when asked.

Behavioral health issues are on the top of the list for the North Carolina Hospital Association, said spokeswoman Julie Henry.

She said people in mental health crisis end up in emergency departments, which are obligated by federal law to do a medical clearance, but that those are not the best places for them.

Henry said hospitals are looking for changes to state law that will allow payment for  emergency medical personnel to bring people in mental health crisis to special crisis centers. There’s been such a pilot program in Wake County that has saved money and kept people from languishing in emergency rooms.

“There are pilots in other counties as well,” said Henry, who also described a peer-based program in Edgecombe and Nash counties that helps people with mental health issues understand and stay compliant with their medications.

She said she felt like there’s a will on the part of lawmakers this year to focus on mental health.

“There’s opportunity for it,” she said. “That’s where we’d like to see them invest their energy because it is a crisis and it’s been demonstrated and everyone’s aware of it.”

Dementia care

Last month, lawmakers heard a presentation by North Carolina Institute of Medicine head Adam Zolotor on the state’s need to plan for helping families affected by Alzheimer’s and other dementias.

After what he considered to be a “positive” reception by lawmakers, Zolotor said he was heartened to see money for respite care services in the governor’s budget. One million dollars would go to Project C.A.R.E., which he called the “only state-specific resource for dementia.”

A healthy brain compared to a brain suffering from Alzheimer's Disease. Photo courtesy of National Institutes of Health
A healthy brain compared to a brain suffering from Alzheimer’s disease. Definitive diagnosis of the disease only occurs upon autopsy and findings of brain-tissue changes such as these. Photo courtesy National Institutes of Health

The program refers family members caring for someone with dementia to resources and counseling. And in the past, the program was also able to provide some respite for caregivers so they could, perhaps, take a weekend off.

“The General Assembly took away about $500,000 in funding that was specially for respite services,” said Zolotor, who was pleased the governor asked for $1 million to restore that funding, while the Joint Legislative Oversight Committee on Health and Human Services asked for only $300,000.

He said a weekend of respite costs about $500. Spread across 100 counties, $1 million means 2,000 families would be able to take a short break.

In their report, the IOM estimated there are more than 160,000 people in the state with Alzheimer’s.

“I was pushing to make it a number where we could actually provide services to a realistic number of people,” Zolotor said.

The number of people with Alzheimer’s and other dementias is expected to grow in the coming decade. Many of those folks could end up in nursing homes if they lack community support. The state’s Medicaid program now spends half its expenditures on elderly in nursing homes. Last year, that was about $1.2 billion on nursing homes and just over $2 billion on all institutional care.

“This portion of the Medicaid budget keeps growing,” Zolotor said. “If we don’t start to look for ways to prevent it, I think it’s going to be a real problem.”

Food and tobacco

“One of the big drivers of obesity in North Carolina and across the  country is lack of access to healthy food,” said Peg O’Connell with the N.C. Alliance for Health.

So she’ll be working to convince Senate lawmakers to fund the $1 million healthy corner store initiative, which would provide support to corner stores to buy refrigerators and storage units to stock fruits and vegetables.

Mecklenburg County students Hannah Douglass and Morgan Rosenhauer show off their temporary tattoos
Mecklenburg County students Hannah Douglass and Morgan Rosenhauer came to the legislature in 2012 to ask for sustained tobacco-prevention funding. Instead, lawmakers eliminated teen tobacco-cessation funds. Photo credit: Rose Hoban

The initiative passed the House in 2015 but got stuck in the Senate. Since the end of last year’s session in October, O’Connell said additional rural areas have become food deserts with the closure of 19 Walmarts across the state.

“Little mom-and-pop groceries were in these little towns and then those WalMarts came in,” she said. “Then they pulled out for business reasons, and the mom-and-pops were already out of business.”

“You know, you lose grocery stores, access to food, it really hits communities hard,” O’Connell said.

She said the N.C. Alliance for Health is also working on $250,000 in tobacco-cessation funding for the You Quit, Two Quit program, aimed at pregnant women.

“It’s really a no-brainer,” O’Connell said. “The single most effective thing you can do to improve a birth outcome is to get the pregnant woman to stop smoking.”

She also will be talking to legislators about funding youth tobacco-cessation programs in light of preliminary data showing an 888 percent increase in e-cigarette use by teens between 2013 and 2015. Lawmakers eliminated teen tobacco-prevention funds in 2012.

“Kids will experiment with e-cigarettes because they’re kind of fun and new, but then they’re also expensive,” she said. “So then they’ll move backwards; then they move on to regular cigarettes because they’re cheaper.”

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