By Thomas Goldsmith

Two Republican state senators on Tuesday proposed a package of health-care reforms, saying specifically that North Carolina should beef up help for people with intellectual disabilities before expanding Medicaid to additional hundreds of thousands of people.

Sens. Joyce Krawiec⁩ (R-Kernersville) and Dan Bishop (R-Charlotte) proposed $41 million in state funding for the IDD population, adding about 2,000 clients during a two-year period to the 12,000 already receiving services under Medicaid’s Innovations Waiver.

“There are another 12,000 on waiting lists and some people don’t bother to sign up because what’s the use?” said Donna Beckmann, director of advocacy of the Triangle Down Syndrome Network and the mother of Thomas, 18, who has Down syndrome.

Mother and son appeared at a North Carolina General Assembly press conference along with Krawiec and Bishop, who announced the Health Care Expansion Act of 2019, filed as SB 361. Krawiec said supplying new funding for the Innovations Waiver should precede the expansion of Medicaid, which Bishop called “frankly a reckless approach.”

But lobbyist Julia Adams-Scheurich, who represents groups advocating for people with disabilities, said the legislature should be investing in both closing the gap in Medicaid coverage and providing for additional waiver slots, “because you’re trying to lift up two different populations, both of whom are needing help.”

Additional provisions of the act would:

  • Repeal the state’s Certificate of Need statute, which requires a permitting process before struction of health-care facilities including hospitals, psychiatric facilities, rehabilitation facilities, nursing homes;, adult care homes or kidney disease treatment centers.
  • Make North Carolina part of the Psychology Interjurisdictional Licensure Compact, a multi-state agreement that allows psychologists to practice across state lines either via telemedicine or face to face.
  • Add licensed marriage and family therapists to the list of professionals allowed to carry out the first evaluation in cases in which involuntary commitment is under consideration.

The proposal quickly drew criticism from Democrats for being a grab bag of proposals that have little to do with each other.

Democratic Sen. Terry Van Duyn (Asheville) said she also supported adding slots for people with intellectual and developmental disabilities.

“I believe the waiting list for [Innovations Waiver] slots is like 10 years long, so that’s a great thing, it’s long overdue,” Van Duyn said.

“But I would sure like a separate debate on certificate of need, because we haven’t really discussed the ins and outs of certificate of need… the implications for our communities,” she said.

She noted that having both proposals in the same bill creates a conundrum, where opponents of certificate of need repeal could then be accused of voting against services for vulnerable people.

“To put those two things together when there is such a tremendous need for expanding the number of slots just seems cynical, extraordinarily cynical,” she said. “We shouldn’t be setting one another up for the next campaign.”

Rose Hoban contributed reporting to this story.

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Thomas Goldsmith worked in daily newspapers for 33 years before joining North Carolina Health News. Goldsmith is a native Tar Heel who attended the UNC-Chapel Hill, and worked at newspapers in Tennessee...