By Rose Hoban
Lobbyists, health care advocates and lawmakers alike spent much of Tuesday poring through hundreds of pages of legal language after the Republican majority members of the General Assembly posted their proposed $23.9 billion state budget online late Monday night.
Members of the Democratic minority criticized Republicans for this year’s unorthodox bill drafting process. Previous years have featured committee hearings, amendments and multiple versions of the budget in a process that gives advocates and other legislators opportunities to plead for funding and point out inconsistencies.
This year, however, that process was largely absent. Instead, the more than 700-page budget was crafted almost completely behind closed doors.
All told, Health and Human Services will receive about $5.3 billion in mostly Medicaid spending but will see a trim of about $37 million from what was allocated last year.
Senate Bill 99 – which includes any policy changes
Conference Committee Report – many line items are noted here
The process did produce some benefits for dozens of not-for-profits around North Carolina which received mostly surprise allocations of state dollars. But there were unpleasant surprises too, for leaders of the state’s publicly funded mental health agencies, which faced cuts in dollars to pay for indigent mental health patients.
And a couple of things were overlooked, such as funding for a suicide hotline, in the rush to produce a budget, write a few bills and recess the short legislative session before the end of the state fiscal year on July 1.
First, the good news
The Health and Human Services section of the budget contained pages of earmarks benefiting select not-for-profits such as food banks, domestic violence shelters, free clinics and more, totaling close to $6 million. Appropriations ranged from $7,500 for the Make a Difference food pantry in Mt. Olive, which is represented by Senate Health Care Committee co-chair Louis Pate, to $750,000 for the Children’s Center of Surry, in the district of Rep. Sarah Stevens (R-Mt. Airy), who has been active in writing legislation to overhaul the state’s child welfare system.
“We ask members if they know of any particular projects in their districts that they think are in need of state support,” said House Speaker Tim Moore (R-Kings Mountain). “They submit those requests and they go through those and we try to fund as many of those as we can.”
But Democrats decried the spending as “pork,” where lawmakers can allocate state spending to pet projects at home to bolster themselves in a tough election cycle.
“I know it, I can smell it,” quipped Democratic House leader Darren Jackson (D-Raleigh) during a press conference.
“We don’t call it pork anymore, we call it ‘member money,’” he said in a sarcastic tone.
But when asked, Moore defended the practice, which was common when Democrats controlled the legislature.
“Certain members who were involved in the budget drafting were given so much money that they could spend in ways they saw fit and so that money has made it into non-profits and things across the state,” he said.
“[Lawmakers] get a lot of appreciation from the folks back home, and it’s money being well spent.”
End of a long process
One spending line that came as a pleasant surprise went to the Durham-based substance abuse treatment program TROSA, which received $6 million in state dollars to help with opening another facility in the Triad.
“Forsyth and Guilford are two of the most-served counties for TROSA right now,” said Keith Artin, TROSA’s chief operating officer. “We’ve been working for a while and looking for awhile at the possibility to create a satellite campus so we can more effectively serve more people.”
Artin said his organization has been making its case at the legislature for several years, as the state’s opioid crisis has deepened.
But he didn’t know if state lawmakers would allocate any money, even though Gov. Roy Cooper had set aside $11 million for the organization in his budget. Many of the governor’s priorities have fallen by the wayside amidst Raleigh’s political wrangling and Artin worried that funding for their expansion would be one of them.
Instead, he received a text from their lobbyist Monday evening saying that the budget was online. “And then I got one from a friend who pays attention about a half hour later saying that TROSA was in the budget,” he said. “As recently as a week ago, I would have told you we weren’t going to get anything.”
Now Artin said the real work begins of making their second facility a reality. The state money will give them a boost as they fundraise from private donors and businesses. He said Blue Cross and Blue Shield of North Carolina has already pledged an additional million.
“The budget for this expansion was originally estimated to be something much bigger… but this is a pretty important part of the puzzle, for sure,” he said. “I think we’ll come up with something that’ll really make an impact.”
And the bad news
Leaders of state-funded mental health managed care organizations (known as LME-MCOs) expressed resignation to learn that state funding to cover services for people who are uninsured had been cut for the fourth year in a row.
This so-called single stream funding has been a bone of contention for lawmakers who have criticized the LMEs for holding onto too many state dollars instead of spending them on developing new services.
One of those services, a mental health crisis center in Wilkes County had been put on hold by Vaya, the LME-MCO for the westernmost part of the state. So, legislators made their wishes known by appropriating $1.4 million to cover the initial costs of the center, and Vaya’s $5.5 million cut to single stream funding shrank to become a $3.8 million cut.
“We’re pleased to see that crisis center funded because it’s a high priority project for us that has been in the queue as part of our community reinvestment plan,” said Vaya head Brian Ingraham. He said his organization has developed two other crisis facilities but had put planning for the Wilkes County center on hold after last year’s cuts.
Ingraham said the new dollars would go a long way to standing up the new center, but he wasn’t sure how to pay for ongoing costs which he estimated at between $1.5-$2 million a year.
“We know that the vast majority of individuals who use [crisis centers] do not have Medicaid,” he said. “That money comes from single-stream dollars and the challenge there is that money is extremely tight, so we’d probably have to look at the budget again.”
“Figuring out how to make it all work and sustaining it, that’s the real art to it,” he said.
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A comment from Steve Yuhasz:
Rose Hoban writes “This so-called single stream funding has been a bone of contention for lawmakers who have criticized the LMEs for holding onto too many state dollars instead of spending them on developing new services.” Actually, Cardinal spent all its State single-stream savings years ago. It has been spending Medicaid savings on non-Medicaid eligible state mandated services at the rate of $1 million /month, now going to be $1.5 million/month. This exhaustion of Medicaid savings in paying for state services leaves little opportunity for the development of new services for Medicaid recipients.
Note: Mr. Yuhasz is a member of the former Cardinal Innovations board of directors.