By Rose Hoban

Even before Democratic Gov. Roy Cooper’s team was able to email out a laudatory press release touting “common ground” in his proposed budget for the coming fiscal year, leaders of the Republican-led General Assembly had emailed reporters their own release, rejecting the governor’s plan and calling it an “unserious attempt to score political points in an election year.”

Cooper’s $24.5 billion plan includes giving hefty raises to teachers and other state employees. And he calls for expanding Medicaid to cover many of the working poor, something that became an option under the Affordable Care Act (also known as Obamacare). Despite Congress’ attempts to undermine the law, the expansion remains an option.

About $1.4 billion in anticipated cost for the expansion would be revenue-neutral to the state, because hospitals and health care systems would foot the bill, according to state budget director Charles Perusse.

“The provider community who would get these additional federal receipts pulled down to provide health care, a portion of that would [go to] help us with the state match,” he said.

Cooper said he believed that the business community has come around to supporting expansion during this legislative session.

“I believe it will happen,” he said. “I hope it will.”

Work requirements

When asked if the governor would support the Carolina Cares bill, proposed last year by Republican members of the House of Representatives, Perusse said Cooper “would be open to any discussion to expanding health care and infusing the state with $4 billion of federal money.”

“We’re up to 32, 33 states that have expanded Medicaid,” Perusse said.

(According to the Kaiser Family Foundation, that number is currently 33 states plus the District of Columbia.)

“If you look at the detail, just as many are Republican states as are Democratic states,” Perusse said. “This is something that makes good economic sense for North Carolina.”

The Carolina Cares proposal includes a requirement that recipients who earn below 133 percent of the federal poverty level ($16,146 for an individual, $33,383 for a family of four) would need to be employed or performing volunteer work in order to qualify for assistance. People who are disabled, in school, performing caregiving duties or who are in substance abuse treatment would be exempted from the work requirement.

An issue brief published last year by the North Carolina Institute of Medicine noted about 60 percent of households that are uninsured and eligible for Medicaid under this expansion are already engaged in part- or full-time work.

“Some state House Republicans support increased access to Medicaid with a work requirement and although the Governor has serious concerns about that he’s pleased that there is some movement on this,” emailed Sadie Weiner, an aide to Cooper, when asked for clarification of the governor’s position.

But throughout the legislative interim, members of the state Senate have expressed their ongoing opposition to any attempts at expansion.

Opioid treatment dollars requested

Cooper also highlighted his proposals to add treatment capacity to the state to address the ongoing crisis of opioid use and overdoses.

“What I’ve heard across the state from law enforcement is that we need to keep going after drug dealers and the drug kingpins, but at the user level, we cannot arrest our way out of this problem,” he said. “They know that treatment is absolutely required to get us out of the grips of the opioid addictions that people have.”

man in a suit points at a large monitor displaying a spreadsheet of numbers
Budget director Charles Perusse outlined to reporters the changes in the tax code Gov. Cooper would like to see lawmakers make in order to pay for his priorities. Photo credit: Rose Hoban

The governor’s budget proposes an additional $9.8 million to support medication-assisted treatment, “on top of an additional $30 million of federal money that we already have for the opioid crisis,” Perusse said.

Additionally, the budget requests $11 million to go to Durham-based drug treatment program TROSA, and other programs which support people moving from addiction, through recovery and back into the workforce.

All told, Cooper asks for $25.7 million in appropriations, for mental health priorities, including funding for a suicide prevention hotline.

Part of that $25.7 million is almost $11 million to staff the newly completed Broughton Hospital in Morganton. Cooper’s budget also earmarks $3.2 million for a program to help people being discharged from psychiatric facilities transition back into their communities.

Smart Start, which provides a number of programs targeting 3- and 4-year-olds and their families with enrichment and early childhood education programs, would see a $15 million boost in the governor’s budget after years of being whittled away by legislative budget writers.

And the proposal would add $2.6 million to increase by 50 the number of people eligible for the Medicaid Innovations waiver program. This program allows for people with disabilities to receive substantial support services allowing them to remain in their homes and avoid institutionalization. Currently, there’s about a 10,000 person waiting list, which legislators reduced by 400 slots in last year’s budget for the same price tag.

However, funding for many of Cooper’s proposals, from teacher raises to recruiting additional nurses to the prison system, would require legislative action to slow down tax cuts enacted in recent years by the Republican-led legislature, something that seems unlikely.

When asked whether he expected a different outcome from last year, where the legislature largely ignored the governor’s proposed budget, Perusse worked to stay upbeat.

“We would hope that the investments in the governor’s budget would open the eyes of the legislature on the needs of the state,” he said. “We’re hearing from the business community and others that there might be some bipartisan support in several of these areas.

“This is always part of the process, the governor, the executive presents and then the legislature goes through their process,” he concluded. “Nothing different as far as that goes.”

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Rose Hoban is the founder and editor of NC Health News, as well as being the state government reporter. Hoban has been a registered nurse since 1992, but transitioned to journalism after earning degrees...