By Rose Hoban
County and health officials in Asheboro will likely breathe a sigh of relief this weekend as a long-desired bill to help the county hospital, which has been in financial trouble in recent years, passed both chambers of the General Assembly and is headed to Gov. Roy Cooper for his signature.
Language from the Rural Health Care Stabilization Act, which was introduced earlier this year by Senate leader Phil Berger (R-Eden) and Randolph County Sen. Jerry Tillman (R-Archdale), had been added to multiple bills this legislative session, looking for a vehicle for passage. The measure finally crossed the legislative finish line tacked onto a catchall bill that had dealt largely with health care licensure, compliance and credentialing.
Senate Bill 537 emerged from a committee on Wednesday significantly altered to include the bill language, which would allow for troubled hospitals to borrow up to $20 million from the state. The funds could then be used to shore up finances as hospitals construct new facilities, for operational costs during a transition to a new facility, or both.
Right now, the only hospital in the state looking for such an infusion of cash is the 145-bed Randolph Health flagship hospital in Asheboro, first constructed during the Depression and updated over the years. The hospital has 1,129 employees and is the county’s fourth largest employer.
According to a county bond issue filing, “Randolph Health, like many other rural hospitals, is experiencing financial challenges as an independent entity. It is exploring other opportunities to improve its financial condition, including the possibility of joining a larger health network.”
Hospital leaders had looked to merge with Greensboro-based Cone Health, but in 2018, Cone called off negotiations.
“I’m thrilled to death,” said Rep. Pat Hurley (R-Asheboro) “Couldn’t be happier to put my county in debt.”
“Praise the Lord, the hospital does have a chance.”
Solution needed ‘very, very soon’
SB 537 doesn’t provide the actual funding to Randolph Hospital, it only creates the mechanism for making the loan. Hurley said that since the legislation has now passed, it will allow the hospital to start the application process to the state.
“They’re going to have to go into bankruptcy, and this is part of the strategic plan for them,” she said.
As in many hospitals, Randolph has a high number of patients on Medicaid and Medicare, which pay less than commercial insurance. According to 2017 (the most recent available) financial statements, the hospital had more than half its revenue from the two public programs, and at least seven percent of expenses were for patients who had no means of payment.
Hurley said the Randolph Health CEO, Angela Orth, has steadied the hospital’s finances and the organization is currently operating in the black. She also said the hospital continues to look for another organization to partner with or buy the system outright.
But she declined to say who the hospital has been talking with. Orth told High Point news station MyFox8 that “We really need a solution very, very soon.”
Any loan application would be reviewed and approved by UNC Health Care, acting in concert with the state.
The actual money for the hospital is tucked into another bill that deals with relief from recent hurricanes, House Speaker Tim Moore (R-Kings Mountain) said.
Adult care home, NCFAST plans in bill
Other provisions in the 55-page bill also call for a study due late next year of how the legislature can address long-standing problems with the financing of adult care homes.
The facilities, which frequently house adults with mental health and developmental disabilities, have had cash flow issues since the legislature changed the way the state pays for Medicaid personal care services in 2012. Since that time, the state has provided “bridge funding” in every biennial budget.
The final bill also contained provisions to delay the rollout of the child welfare component of NCFAST, the information technology system used by county social service departments to determine eligibility for many entitlement programs.
Problems with the software were raised during a legislative hearing in March. Since then, DHHS and counties that have been piloting the software have been working with IBM to redesign the system. Legislators decided to forge ahead with improving the program, rather than scrapping it and purchasing an off-the-shelf solution because the state would have been on the hook to repay the federal government some $50 million that North Carolina received in support.
Another provision in the bill adds a requirement for criminal background checks on child care workers working in child care group homes and other child welfare institutions.
Medicaid expansion stalemate persists
In the confounding and often tumultuous tail end of the legislative session, bill language gets tucked into other bills or bills get sent to a conference committee where they emerge looking sometimes radically different.
“You could have a conference report that deals with one bill and the original bill did and you can adopt a conference report that has an entirely different subject matter,” Moore said.
For example, one bill contained an attempt to add a tax to e-cigarette and vaping products.
Rep. Cynthia Ball, a Wake County Democrat, was able to get the proposal through a House finance committee meeting.
But the new tax was snuffed out quickly and excluded from a bill later adopted by the House and Senate.
Other health care bills shared similar fates or were not heard at all. Included in that group is the so-called “mini-budget” that addresses financing for the Medicaid managed care transformation that’s slated to start early next year. A lack of funding leaves the timing of the policy change in doubt.
Moore said that he’s told Rep. Donny Lambeth (R-Winston-Salem) that any time he wants a vote on Lambeth’s bill to expand the Medicaid program to low-income workers, he can have it.
But, according to Moore, Lambeth is working to find a way for the bill to be palatable to the Senate.
“Instead of just trying to send something over (to the Senate), it’s been more like trying to work and see if he can come up with something that actually passes,” Moore said.
The adjournment resolution passed by both chambers stipulates the legislature will return in mid-November to deal with redistricting issues and then again in January to possibly take up expansion and other health care issues.
But as the House prepared to vote on the adjournment resolution, minority leader Darren Jackson (D-Raleigh) got up to object to the delay on Medicaid expansion.
“Thirty-seven states have already taken action to expand their Medicaid program. I believe that North Carolina should be the next one,” he said. “It would help a half a million people get access to affordable health care … over 500,000 working people that are one illness, one major injury away from bankruptcy.
“In every county, in every district of this state, there’s someone who would benefit and who would be harmed by waiting an additional two months.”
NC Health News Reporter Anne Blythe contributed to this report.
Republish our articles for free, online or in print, under a Creative Commons license.
Part III (e); They removed section regarding SCFAC, both parts. IMO they nay have thought it was adding more seats than it really was.
We can approach Dobson, Krawiec, and Hise before the ‘short’ session opens January 14. These changes are needed. The addition of TBI lays groundwork for across the board inclusion of this previously much ignored population (persons with TBI not classified as IDD, and eligible for TBI Waiver, and their family members) for inclusion in advisory roles to legislators, DHHS, LME/MCOs, and PHPs…