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By Rose Hoban
North Carolina lawmakers are due back in Raleigh today for what is shaping up to be a short budgetary session, likely made shorter by Congress’s lack of action on coronavirus funding.
When lawmakers were last in town, they appropriated $1.5 billion in funding that had been sent to the state as a result of Congressional action to pass the CARES Act. Hundreds of millions of dollars from that appropriation went to finance health and human services priorities such as testing for COVID-19, enhanced payment to child care providers, more mental health services and help for hospitals and health care providers.
There’s still money left out of North Carolina’s federal funding and there had been looming questions about the level of flexibility Congress would give states to potentially use the dollars to backfill deficits created by state tax revenues decimated by the economic damages of the pandemic.
But legislative leaders signaled Tuesday they were willing to put all of that funding toward paying for needs generated by the pandemic, rather than waiting to see if Congress would act. The office of state Senate leader Phil Berger (R-Eden) released a proposed bill that would appropriate $2.36 billion toward COVID-19 recovery, using up the remainder of federal Coronavirus Relief Funds.
Today’s session also comes just a week after a $25 billion budget proposal made by Gov. Roy Cooper, which includes just under a billion dollars for COVID expenditures. That plan also would have expanded the Medicaid program, something that would not require any state dollars.
Instead of going for Cooper’s budget, legislative leaders are planning to allocate those remaining COVID-19 dollars, layered on top of what would be the second year of budget continued from 2018, after the legislature and the governor failed to agree on a budget last year.
Notably, in the proposed Senate bill, Medicaid expansion is not mentioned.
Multitude of health care priorities
In August, members of the Health Care Working Group, a subset of the House Select Committee on COVID-19, met to mark up proposed spending requests for health and human services funding made by the state Department of Health and Human Services, as well as health care industry and advocacy groups.
For example, the North Carolina Early Education Coalition requested $5.7 million and the North Carolina Senior Living Association made a request of $7 million each to cover the costs of personal protective equipment to protect both workers and care recipients.
“One of the big concerns is making sure that the staff is being tested regularly and is not bringing COVID-19 into congregate living settings,” Mark Collins, an analyst from the legislative Fiscal Research Division, told lawmakers during the meeting.
But those were only the small items. All told, lawmakers contemplated as much as $577 million worth of spending on priorities created by COVID-19.
Rep. Donny Lambeth (R-Winston-Salem) lead the group through a spreadsheet of financial requests that ranged in size from $100,000 for testing wastewater for evidence of COVID-19 in the sewage of several senior living facilities to a $100 million request to go to hospitals that did not receive federal rural or safety net support distributions.
“All we’re doing at this point is trying to fit a list of requests in that would be passed over to the appropriation chairs for them to use in their discussions with the Senate,” Lambeth said. “The Senate’s gonna have their own list of priorities and requests and we’ll have to negotiate.
“I’m not under any kind of preconceived notion that we’ll get our list 100 percent.”
Lambeth told colleagues to prioritize funding requests on a three-tier basis, with the assumption that lower priority requests might see funding when and if Congress appropriates more relief money to states.
“It’s gonna be a hard sell for additional rate money right now when we are probably pressed right now for some other needs,” he said.
Funds for long-term care, mental health
By mid-August, the Department of Health and Human Services had received more than $345 million of federal Coronavirus Relief Funds from the General Assembly, according to Secretary Mandy Cohen. She assured legislators that the money would be spent by the end of the year.
One of her priorities for more funding was for dollars to stem infections in congregate care living facilities such as nursing homes and senior residences which have accounted for nearly half of the state’s 2,741 deaths from COVID-19 infections.
She also expressed concern about the ability for long-term care facilities to retain the nurses and nursing aides that make those facilities run. Her hope was the legislature would allow for increased pay rates for those workers, along with an uptick in pay for home care nursing and personal care services delivered to disabled people living in their own homes.
The bill released Tuesday did not mention funding for those priorities but did allow for $23 million to be distributed by industry groups representing long-term care to those facilities that need it. The bill earmarks money for personal protective equipment and other COVID-related supplies.
Another large request had come from the state’s addiction professionals, who were looking for $113 million to cover increased costs, both past and future, for behavioral health needs that have spiked during the pandemic.
According to documentation provided to the Health Care Working Group, there’s been an 11 percent increase in opioid overdoses since the onset of the pandemic. A survey of behavioral health provider groups found more than half of programs discontinuing some services, and 10percent were unable to admit new clients.
The proposed bill, instead, provides $38 million in state funding to the state’s mental health management entities to provide “direct services associated with the COVID-19 pandemic.”
Other appropriations in the proposed bill:
- $25 million for the N.C. Medical Society to be distributed to independent health care practices with “demonstrable financial needs related to COVID-19”
- $20 million to DHHS to reimburse providers who participate in the Medicaid program to reimburse for care given to uninsured patients
- $14.3 million to a coalition of textile manufacturers to prototype, test and provide reusable personal protective equipment
- $9 million to UNC-Charlotte for the development of a “novel COVID-19 monitoring program based on the presence of the virus in wastewater and public transportation systems”
- $20 million to DHHS to support a variety of organizations, such as food banks, domestic violence shelters, homeless shelters, etc., with extra expenses