By Rose Hoban
Scarcely two weeks after members of the state House of Representatives completed their spending plan for the coming year, members of the Senate responded with their own proposal, a plan that makes significant trims to health and human services spending while providing a dramatic pay hike for North Carolina’s teachers.
The Senate’s health care plan calls for 3.4 percent less in spending than last year, largely resulting from a Medicaid program that came in more than $313 million below its $3.7 billion budget target.
“It’s good to not be stealing from every other area of the budget to fund for Medicaid this year, as we’ve done so many times in the past,” said Health and Human Services appropriations chair Sen. Ralph Hise (R-Spruce Pine).
“A lot of work has gone into placing us into a position to be able to do that this year.”
The senate’s plan actually represents 5.9 percent less spending than than the amount lawmakers originally appropriated for this year.
Senate leader Phil Berger (R-Eden) called the $22.2 billion state budget “bold,” in that it provides pay hikes and performance-based bonuses for teachers and state employees such as magistrates and highway patrol officers, bulks up the state’s rainy day fund, and cuts taxes by an additional $350 million.
But the plan is sure to disappoint many health care advocates, who walked away from the House budget plan with their programs largely unscathed. And it will likely disappoint many health and human services workers, who don’t share in the pay raises offered to other state employees.
Some losers
During a press conference on the budget Tuesday, Berger said he was hard pressed to think of any cuts that might be contained in the budget. But the HHS portions of the document contained plenty of trims that could cause pain.
For the fifth year running, Senate budget writers eliminated about $2.1 million in funding for the Wright School, a boarding school located in Durham that provides structured learning for kids with severe emotional and behavioral problems.
The school “provides limited services in a small region of the state, making services unavailable in the rest of the state,” Hise told the Senate Appropriations Committee Wednesday morning.
But House budget writer Nelson Dollar (R-Cary) said he was disappointed that the school was in the budget crosshairs again.
“I think it’s sad to hold those children and those families hostage in a budget process,” Dollar said. “I really think that we should focus on the bigger issues.”
Asked about the argument that the school only provides services in the central part of the state, Dollar said he would like to see more, not fewer, such services offered.
“I think the case is made by the results that we have seen in 50 years,” he said. “The fact [is] that some serious behavioral health issues that could easily lead to violence for an individual and our society are diverted because of the work and the model that’s used at the Wright School… In my view, I think we should have more Wright Schools available in more areas of the state.”
Gov. Pat McCrory’s recently completed Task Force on Mental Health and Substance Use recommended that the state create a reserve fund of $30 million to pay for increased services for kids with mental health issues, transitional housing for people leaving prison or psychiatric facilities, and treatment for opiate addiction.
The House moved to adopt the recommendations from the task force, including the full $30 million request from the governor, whereas the Senate has created only a $10 million reserve. Instead, the Senate plan lays out a “strategic plan” for improvement of behavioral health services, including the creation of a new legislative subcommittee on behavioral health services.
Other gaps:
- Senators would compel mental health local management entities to consolidate, as ordered by HHS Secretary Rick Brajer, to have $30 million restored out of $152 million in fund balances reclaimed by the state in the budget year ending June 30.
- House budget writers had increased rates paid by state and county “special assistance” funds to adult care homes to cover care for Medicaid residents. Adult care homes had not seen a rate increase since 2009. The Senate makes no mention of adult care home rates.
Aggressive
Children experiencing mental health crises would have more options for care if Senate budget writers had their way.
Their budget takes $2 million to create freestanding centers for young people in such situations. The money would be seed funding to get the new centers up and running.
Senate budget writers also took a much more aggressive stance on physicians’ use of the state’s controlled-substance reporting system, which tracks patients who get prescriptions for opioid drugs. Senators add $600,000 to upgrade the database, annual funding of $375,000 for ongoing maintenance, and $653,400 to develop analytics to identify people who might be abusing the drugs.
Under the Senate plan, doctors would be obligated to sign up for the system and use it when prescribing narcotics. Doctors who didn’t comply could lose their licenses.
It’s a move that physicians have resisted, but lawmakers say they’re frustrated that only about one in five doctors has signed up for the system.
“Hopefully [this will] begin to give us the information we need to turn the tide on prescription drug abuse in this nation,” Hise said. “And get something that we can actually have physicians utilizing through their prescription writing.”
Another Senate recommendation came in response to a recent report from the State Auditor examining delays in processing Medicaid applications in 2013-14, when some people waited months before they learned whether they were eligible for the program. The Senate budget contains language forcing county workers to get Medicaid recipients’ signed up for the program more quickly, and allows for a temporary state takeover of a local Department of Social Services if timeliness benchmarks are not being met.
Minali Nigam contributed reporting to this story.
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