This past week, North Carolina lawmakers released and then passed a $20.6 billion budget to fund state services and departments for the coming fiscal year. But one of the problems with the state budget is that it can be difficult to decipher. That’s in part a function of the size and complexity of running a state government that serves 9.5 million people, and it’s also in part a deliberate choice on the part of lawmakers to obscure policy decisions buried in the numbers.
At North Carolina Health News, we spent hours slogging through the text and the numbers to make this year’s budget more discernible to the lay reader.
Below is a data visualization that can help you understand the budget; you can click on boxes in the budget to get a sense of the size of different state programs and whether they gained or lost funding.
Right click (Mac users, control-click) to return to the main DHHS budget image.
Special thanks to Steve Tell for his help in creating this graphic.
This spreadsheet details how parts of the Health and Human Services budget evolved over the months since the initial Senate budget was presented and passed in May. The final budget bill passed on Wednesday and went on to Gov. Pat McCrory for his signature.
Budget Comparison: Colored boxes denote significant changes from either the House or Senate budgets, or both.
House |
Senate |
Final Budget |
| Requires DHHS to prepare detailed plan to reform Medicaid; establishes 22-member Medicaid reform advisory committee. Report due no later than the beginning of the 2014 short session. |
Requires DHHS to prepare detailed plan to reform Medicaid. Report due no later than March 17, 2014. |
Requires DHHS to prepare detailed plan to reform Medicaid that includes how DHHS will decide on the plan they eventually pick. The proposal also must include details on pilot programs, plans for integrating physical and mental health and a “realistic” timeline for implementation. Report due no later than March 17, 2014. |
| Sets tighter guidelines for amending the state’s Medicaid State Plan and applying for Medicaid waivers from the federal Centers for Medicare and Medicaid Services. | Sets tighter guidelines for amending the state’s Medicaid State Plan and applying for Medicaid waivers from the federal Centers for Medicare and Medicaid Services. | Sets tighter guidelines for amending the state’s Medicaid State Plan and applying for Medicaid waivers from the federal Centers for Medicare and Medicaid Services. |
| Provides incentives to counties to share in Medicaid/Medicare fraud-recovery activities | Provides incentives to counties to share in Medicaid/Medicare fraud-recovery activities | Provides incentives to counties to share in Medicaid/Medicare fraud-recovery activities by using up to 2% of money from county child-care subsidy funds. |
| Changes Medicaid to comply with implementation of the Affordable Care Act; creates new procedures for changing medical policies in Medicaid or the SCHIP (Health Choice); requires greater legislative oversight. Requires DHHS to create and present a detailed report on the 5-year projected costs and submit for review any proposed changes. |
Changes Medicaid to comply with implementation of the Affordable Care Act Creates new procedures for changing medical policies in Medicaid or the SCHIP (Health Choice); requires greater legislative oversight. Requires DHHS to create and present a detailed report on the 5-year projected costs and submit for review any proposed changes. |
Changes Medicaid to comply with implementation of the Affordable Care Act; creates new procedures for changing medical policies in Medicaid or the SCHIP (Health Choice); requires greater legislative oversight. Requires DHHS to create and present a detailed report on the 5-year projected costs, and submit for review any proposed changes. |
| Gives DHHS authority to enact any amendments to the state’s Medicaid plan that have been approved by the federal Centers for Medicare and Medicaid services, but also allows the department to adopt temporary rules as necessary. | Requires DHHS to get permission from the Rules Review Commission and the Office of State Management and Budget in order to enact any state plan amendments, but also allows the department to adopt temporary rules as necessary. | Requires DHHS to get permission from the Rules Review Commission and the Office of State Management and Budget in order to enact any state plan amendments, but also allows the department to adopt temporary rules as necessary. |
| Sets eligibility for Medicaid: Elderly, blind and disabled <= 100% federal poverty level ($11,490 for a single person); pregnant women up to 185% of the FPL ($21,256); infants and children up to five years of age with family income less than 200% of the FPL ($47,100 for a family of four); children aged 6-18 years of age with family incomes up to 100% of FPL ($23,550 for a family of four) until Jan 1, 2014, when the Affordable Care Act goes into effect; children aged 6-18 in families earning less than 133% FPL ($31,322 for a family of four), after Jan 1, 2014, when the Affordable Care Act goes into effect. Workers with disabilities earning less than 150% FPL ($17,235 for a single person). |
Sets eligibility for Medicaid: – Elderly, blind and disabled <= 100% federal poverty level ($11,490 for a single person) – Infants and children up to five years of age with family income less than 200% of the FPL ($47,100 for a family of four); children aged 6-18 years of age with family incomes up to 100% of FPL ($23,550 for a family of four) until Jan 1, 2014, when the Affordable Care Act goes into effect; children aged 6-18 in families earning less than 133% FPL ($31,322 for a family of four), after Jan 1, 2014, when the Affordable Care Act goes into effect; workers with disabilities earning less than 150% FPL ($17,235 for a single person). |
Sets eligibility for Medicaid: Elderly, blind and disabled <= 100% federal poverty level ($11,490 for a single person); pregnant women up to 185% of the FPL ($21,256); infants and children up to the age of five, with family income less than 200% of the FPL ($47,100 for a family of four); children aged 6-18 years of age with family incomes up to 100% of FPL ($23,550 for a family of four) until Jan 1, 2014, when the Affordable Care Act goes into effect; children aged 6-18 in families earning less than 133% FPL ($31,322 for a family of four), after Jan 1, 2014, when the Affordable Care Act goes into effect; workers with disabilities earning less than 150% FPL ($17,235 for a single person). |
| Others eligible for Medicaid include: adoptive children with special needs, independent foster care adolescents, low-income women who need treatment for breast or cervical cancer | Others eligible for Medicaid include: adoptive children with special needs, independent foster care adolescents, low-income women who need treatment for breast or cervical cancer | Others eligible for Medicaid include: adoptive children with special needs, independent foster care adolescents aged from 18-20, low-income women who need treatment for breast or cervical cancer |
| As funds allow, Medicaid may also enroll children who are in families with incomes between 133% FPL and 200% FPL (between $31,322 and $47,100 for a family of four) | As funds allow, Medicaid may also enroll children who are in families with incomes between 133% FPL and 200% FPL (between $31,322 and $47,100 for a family of four) | As funds allow, Medicaid may also enroll children who are in families with incomes between 133% FPL and 200% FPL (between $31,322 and $47,100 for a family of four) |
| Retains pregnant women up to 185% FPL on Medicaid. | Establishes the “Insurance Premiums for Pregnant Woman” program: Moves pregnant women earning under 185% FPL and not having access to other forms of insurance onto health insurance plans offered on the federally run Health Benefits Exchange, with premium assistance paid by state funds after Jan 1, 2014, when the ACA goes into effect. However, this is not defined as an entitlement. |
Retains pregnant women up to 185% FPL on Medicaid. |
| Provision allows young people who turn 19 after June 1, 2013 and who are due to lose Medicaid eligibility to retain coverage in the State Children’s Health Insurance Plan (NC Health Choice) until Jan 1, 2014, when the ACA goes into effect and they can buy health insurance on the federally run Health Benefits Exchanges. | No mention of 19-year-olds retaining Health Choice coverage. | Provision allows young people who turn 19 after June 1, 2013 and who are due to lose Medicaid eligibility to retain coverage in the State Children’s Health Insurance Plan (NC Health Choice) until Jan 1, 2014, when the ACA goes into effect and they can buy health insurance on the federally-run Health Benefits Exchanges. |
| No inflationary increases for Medicaid services; co-pays, reimbursement rates and fees remain the same unless specifically changed by the General Assembly. Exceptions: hospital charges to account for inflation, community health centers, rural health centers, state-operated services, hospice, Medicare Part B & D premiums, HMO premiums, pharmaceuticals, MCO capitation payments, nursing home direct care services |
No inflationary increases for Medicaid services; co-pays, reimbursement rates and fees remain the same unless specifically changed by the General Assembly. Exceptions: hospital charges to account for inflation, community health centers, rural health centers, state-operated services, hospice, Medicare Part B & D premiums, HMO premiums, pharmaceuticals, MCO capitation payments, nursing home direct care services |
No inflationary increases for Medicaid services; co-pays, reimbursement rates and fees remain the same unless specifically changed by the General Assembly. Exceptions: hospital charges to account for inflation, community health centers, rural health centers, state-operated services, hospice, Medicare Part B & D premiums, HMO premiums, pharmaceuticals, MCO capitation payments, nursing home direct care services |
| Medicaid beneficiaries are entitled to 22 health care visits, but beneficiaries must get prior authorization for anything beyond 10 visits. Only entitled to 3 visits per year for adult rehabilitation set-up and evaluation. Must receive prior authorization required for more than 4 brand-name prescriptions. |
Medicaid beneficiaries are entitled to 22 health care visits, but beneficiaries must get prior authorization for anything beyond 10 visits. Limited to adult private-duty nursing at the rate of $432/ day only entitled to 3 visits per year for adult rehabilitation set-up and evaluation. Must receive prior authorization required for all mental health drugs, with a addition of provision for 72-hour emergency supply. |
Medicaid beneficiaries are entitled to 22 health care visits, but beneficiaries must get prior authorization for anything beyond 10 visits; however, this does not apply to people with chronic conditions. Only entitled to 3 visits per year for adult rehabilitation set-up and evaluation. The state Medicaid program has the option of requiring patients to receive prior authorization required for all mental health drugs, with a addition of provision for 72-hour emergency supply. |
| Reduces state Medicaid reimbursement to hospitals from 80% of hospital costs to 70% of costs. | Reduces state Medicaid reimbursement to hospitals from 80% of hospital costs to 70% of costs. | Reduces state Medicaid reimbursement to hospitals from 80% of hospital costs to 70% of costs. |
| Sets a single, flat fee to reimburse for Medicaid-covered emergency department visits, which cannot be cost-settled. | Sets a single, flat fee to reimburse for Medicaid-covered emergency department visits, which cannot be cost-settled. | No mention of a flat-fee emergency department reimbursement. |
| Orders DHHS to work with Community Care of North Carolina to improve pharmacy management and identify patients who use many drugs and work on reducing the cost of their use. | No mention of pharmacy management. | Orders DHHS to work with Community Care of North Carolina to improve pharmacy management and identify patients who use many drugs and work on reducing the cost of their use. |
| Funds 32 positions to increase Department of Health and Human Services internal audit capacity | Funds 32 positions to increase DHHS internal audit capacity | Funds 32 positions to increase DHHS internal audit capacity; also adds 10 positions to investigate complaints, conduct surveys for uncredentialed hospitals and monitor abortion clinics on an annual basis |
| Changes the process for providing funds to not-for-profit agencies that provide health and human services. New competitive bidding process starts in fiscal year 2014. Allocates $12.5 million/year for 2013-15; details allocations to each agency for the FY. | Changes the process for providing funds to not-for-profit agencies that provide health and human services. New competitive bidding process starts in fiscal year 2013; allocates $14.8 million/year for 2013-14 only. | Changes the process for providing funds to not-for-profit agencies that provide health and human services. New competitive bidding process starts in fiscal year 2013; allocates $13.7 million for fiscal year 2013-14 and $9.8 milion for fiscal year 2014-15. |
| Medication Assistance Program that assists low-income, uninsured to get free prescriptions, at rate of $1,704,033/year | No allocation for Medication Assistance Program | Medication Assistance Program that assists low-income, uninsured to get free prescriptions, at rate of $1,704,033/year |
| Provides $8 million for FY 2013-14 to cover mental health group homes personal care assistance, at rate of $15.26/day | No mention of group homes for mentally ill | Provides $4.6 million for group homes that house people with mental illnesses. The money will also help support people with intellectual or developmental disabilities who live in group homes. The money will be distributed among about 1,500 people with mental health disabilities and an unknown number of people with I/DD. This provision only applies to people who were living in group homes before Jan 1, 2013. |
| $400,000/year to NC MedAssist Program to expand capacity of statewide pharmacy program | No mention of NC MedAssist | $400,000/year to NC MedAssist Program to expand capacity of statewide pharmacy program |
| Medicaid Management Information System: replace money and report due dates; similar language to Senate | Medicaid Management Information System: replace money and report due dates; also provides funds for integration of fraud-detection system | Medicaid Management Information System (NCTracks): allocates $4.8M to complete implementation of the new computer system, also sets up dates for the Department of Health and Human Services to report to the legislature. By Sept.1, a report on how implementation is going; by Nov 1, a report on full implementation with updated costs; by Dec 1, a report on transferring money and personnel from the old to the new system; and by Jan 1, a report on how DHHS plans to have the new system certified by the federal Medicaid agency. |
| Provides for additional $864,000 to complete NC FAST implementation in FY 2014-15. Computerized system will be used to determine eligibility for Medicaid, Work First and other entitlement programs. | Provides for additional $864,000 to complete NC FAST implementation in FY 2014-15. Computerized system will be used to determine eligibility for Medicaid, Work First and other entitlement programs. | Provides for additional $864,000 to complete NC FAST implementation in FY 2014-15 on top of $13.2 million in costs over the biennium. Computerized system will be used to determine eligibility for Medicaid, Work First and other entitlement programs. |
| Allows for $1 million in medical liability insurance for doctors and dentists practicing under DHHS aegis, including faculty and residents at UNC School of Medicine | Allows for $1 million in medical liability insurance for doctors and dentists practicing under DHHS aegis, including faculty and residents at UNC School of Medicine | Allows for $1 million in medical liability insurance for doctors and dentists practicing under DHHS aegis, including faculty and residents at UNC School of Medicine |
| Reduces Justus Warren Stroke Prevention Task Force to semi-annual rather than quarterly; eliminates subcommittees | Reduces Justus Warren Stroke Prevention Task Force to semi-annual rather than quarterly; eliminates subcommittees | Reduces Justus Warren Stroke Prevention Task Force to semi-annual rather than quarterly; eliminates subcommittees |
| No mention of Commission for the Blind | Modifications to Commission for the Blind | Modifications to Commission for the Blind, including increasing the number of members to 19. |
| Sets eligibility and payment standards for Work First Program | Requires drug testing in order to receive Work First (welfare) benefits. Payment for drug test is responsibility of recipient, to be reimbursed once comes back negative. | HB 392 would codify that TANF and Work First recipients have a criminal background check and drug screen before qualifying for benefits. At the time of publication, the bill had passed the House and was sent to the Senate for concurrence. |
| Repeals Child Fatality Task Force starting July 2014 | No mention of Child Fatality Task Force | Child Fatality Task Force is preserved |
| No mention of child-abuse reporting issues | Creates DSS study on procedures for reporting child abuse | Creates DSS study on procedures for reporting child abuse |
| Creates promotion fund to encourage adoption of kids in foster care; allocates $1.5 million/year for 2013-15; creates foster care “permanency” initiative, allocating $3.75 million over two years to Children’s Home Society; creates legislative oversight committee for permanency initiative | No mention of foster care issues | Creates promotion fund to encourage adoption of kids in foster care; allocates $1.5 million/year for 2013-15; creates foster care “permanency” initiative, allocating $3.75 million over two years to Children’s Home Society; creates legislative oversight committee for permanency initiative |
| Keeps Project CARE (Caregiver Alternatives to Running on Empty) at current funding level of $500,000 | Statewide implementation of Project CARE at cost of $2.9 million/year. Does this by reducing Home and Community Services Block Grant by the same amount. | No mention of Project CARE |
| Reduces the Home and Community Block Grant by $500,000 to support Project CARE; $27 million remains to provide home and community-based services to seniors and disabled adults | Reduces the Home and Community Block Grant by $2,900,000 to support Project CARE; $24.6 million remains to provide home and community-based services to seniors and disabled adults | No mention of Project CARE |
| Sets inspection rates for “temporary food establishments” at $95, $75 of which goes to local health departments | Sets inspection rates for “temporary food establishments” at $120, $75 of which goes to local health departments | Sets inspection rates for “temporary food establishments” at $120, no more than $50 of that can go to local health departments |
| No mention of Oral Health program | Eliminates 39 dental hygiensts, two dental techs and seven administrative positions from statewide program under the Oral Health Section of the Division of Public Health, removing $6.5 million; moves $3.65 million of that money to local health departments | Eliminates at least 15 full-time positions within the Oral Health Section of the Division of Public Health, saving $637,500 during FY 2013-14 and at least $850,000 during FY 2014-15 |
| Sets standards and duties for school nurses; same language as Senate | Sets standards and duties for school nurses | Sets standards and duties for school nurses |
| Orders Division of Public Health to cut four of the state’s Child Developmental Service Agencies; reduces personnel by $8 million of non-recurring funds in the first year of the biennium and by $10 million of recurring funds in the second year, reducing the workforce by 160 staff (out of approximately 800 staff) | Orders Division of Public Health to cut four of the state’s Child Developmental Service Agencies; reduces personnel by $8 million of non-recurring funds in the first year of the biennium and by $10 million of recurring funds in the second year, reducing the workforce by 160 staff (out of approximately 800 staff) | Orders Division of Public Health to cut four personnel at the the state’s Child Developmental Service Agencies by a total of $8 million of non-recurring funds in the first year of the biennium and by $10 million of recurring funds in the second year, reducing the workforce by 160 staff (out of approximately 800 staff). Gives DPH the capability to close up to four of the agencies. |
| NC Reach Program to help pay for college tuition for former foster youth increased by $551,690 to cover 10% annual growth in the program; covers items such as books, supplies, transportation and room and board not covered by other funding sources | NC Reach Program to help pay for college tuition for former foster youth, increased by $1,158,062 over two years to increase the program by an additional 100 students; covers items such as books, supplies, transportation and room and board not covered by other funding sources | NC Reach Program to help pay for college tuition for former foster youth increased by $600,000 to cover growth in the program; covers items such as books, supplies, transportation and room and board not covered by other funding sources |
| Cuts AIDS Drug Assistance Program by $8 million in recurring funds in both years; directs Division of Public Health to explore options for covering people with HIV/AIDS on new federal health benefit exchanges | Cuts AIDS Drug Assistance Program in both years by $8 million in recurring funds and adds $6 million in non-recurring (one-time) funds; directs Division of Public Health to explore options for covering people with HIV/AIDS on new federal health benefit exchanges | Cuts AIDS Drug Assistance Program by $8 million in recurring funds in both years; directs Division of Public Health to explore options for covering people with HIV/ AIDS on new federal health benefit exchanges |
| Eliminating Health Disparities Initiative: provides grants up to $300,000 to 12 entities to focus on eliminating health disparities among African-Americans, Latinos and Native Americans | Eliminating Health Disparities Initiative: provides grants up to $300,000 to 12 entities to focus on eliminating health disparities among African-Americans, Latinos and Native Americans | Eliminating Health Disparities Initiative: provides grants up to $300,000 to 12 entities to focus on eliminating health disparities among African-Americans, Latinos and Native Americans |
| Provides no funding for teen tobacco prevention; provides $1 million for the Tobacco Quitline | Provides no funding for teen tobacco prevention; provides $1.4 million for the Tobacco Quitline | Provides no funding for teen tobacco prevention; provides $1.2 million for the Tobacco Quitline |
| Directs Division of Public Health to develop strategic plan to improve health services, increase awareness and develop initiatives to improve men’s health | Directs Division of Public Health to develop strategic plan to improve health services, increase awareness and develop initiatives to improve men’s health | Directs Division of Public Health to develop strategic plan to improve health services, increase awareness and develop initiatives to improve men’s health |
| Increases Medical Examiner autopsy fees to $1,250 from $1,000 | Increases Medical Examiner autopsy fees to $1,250 from $1,000 | Increases Medical Examiner autopsy fees to $1,250 from $1,000 |
| Establishes statewide telepsychiatry program; places program under the Office of Rural Health | Establishes statewide telepsychiatry program; places program under the Division of Mental Health | Establishes statewide telepsychiatry program; places program under the Office of Rural Health. |
| Allocates $38 million/year to pay for mental health beds in local hospitals | Allocates $38 million/year to pay for mental health beds in local hospitals | Allocates $38 million/year to pay for mental health beds in local hospitals |
| Creates recurring funds for Child Maltreatment Program of $1.8 million and non-recurring funds of $250,000 annually to provide clinical training to Medicaid-certified physicians and child-trauma treatment services and develop an online database | Creates recurring funds for Child Maltreatment Program of $1.8 million and non-recurring funds of $250,000 annually to provide clinical training to Medicaid-certified physicians and child trauma treatment services and develop an online database | Creates recurring funds for Child Maltreatment Program of $1.8 million and non-recurring funds of $250,000 annually to provide clinical training to Medicaid-certified physicians and child trauma treatment services and develop an online database |
| Creates six-county special-assistance pilot program to test two-tiered rates to provide personal care services for people in group homes and assisted-living residences and for Medicaid-eligible people living at home. Sets rates for County “Special Assistance” payments at $1,182 for adult care home residents and $1,515 for those in Alzheimer’s/dementia special-care units (rates same as last year). | Creates six-county special assistance pilot program to test two-tiered rates to provide personal care services for people in group homes and assisted-living residences and for Medicaid-eligible people living at home. Does not set rates for county “special assistance” payments. | Creates six-county special-assistance pilot program to test two-tiered rates to provide personal care services for people in group homes and assisted living residences and for Medicaid-eligible people living at home. Sets rates for County “Special Assistance” payments at $1,182 for adult care home residents and $1,515 for those in Alzheimer’s/dementia special-care units (rates same as last year). |
| Directs DHHS to have mental health local management entities/managed care organizations create clinical “integration” program for Community Care of North Carolina to work with mental health agencies to cover physical health needs of people with mental health issues | No mention of clinical-integration program. | Directs DHHS to have mental health local management entities/managed care organizations create clinical “integration” program for Community Care of North Carolina to work with mental health agencies to cover physical health needs of people with mental health issues |
| Preserves Wright School | Closes the Wright School, a residential school for children with mental health and behavioral disorders, saving $2.7 million/year | Preserves Wright School |
| Provides additional $250,000 to adult developmental vocational program to reduce waiting list for services | No allocation mentioned | No allocation mentioned |
| No mention of Mental Health information-systems project | Directs Division of Mental Health to halt current work on information system project and submit a detailed report on how such a system would integrate with mental health agencies around the state, costs and operational needs | Directs Division of Mental Health to halt current work on information system project and submit a detailed report on how such a system would integrate with mental health agencies around the state, costs and operational needs; sets criteria for restarting the project |
| Directs mental health local management entities/managed care organizations to put some part of their funds to substance-abuse prevention and education activities; mandates $300,000 to increase treatment and services for people serving time in the criminal justice system | Directs mental health local management entities/managed care organizations to put some part of their funds to substance-abuse prevention and education activities; mandates $300,000 to increase treatment and services for people serving time in the criminal justice system | Directs mental health local management entities/managed care organizations to put some part of their funds to substance-abuse prevention and education activities; mandates $300,000 to increase treatment and services for people serving time in the criminal justice system |
| Maintains state-operated alcohol and drug-abuse treatment centers | Closes state-operated alcohol and drug-abuse treatment centers; appropriates $30 million of that funding to LME/MCOs to provide community-based and residential substance-abuse treatment services | Preserves state-operated alcohol and drug-abuse treatment centers, but reduces the budget for each center by 12 percent for a total $4.9 million cut. |
| No mention | Allows mental health LME/MCOs to offer higher benefits to candidates for director positions, including severance, relocation and funds not currently allowable under state personnel act | Allows mental health LME/MCOs to offer higher benefits to candidates for director positions, including severance, relocation and funds not currently allowable under state personnel act. This was codified in law by legislature in Senate Bill 223, which passed both House and Senate and is awaiting the governor’s signature. |
| Eliminates comprehensive report on medication-related errors in nursing homes | Eliminates comprehensive report on medication-related errors in nursing homes | Eliminates comprehensive report on medication-related errors in nursing homes |
| No mention | Creates a three-year moratorium on new licenses for Alzheimer’s/dementia special-care units | Creates a three-year moratorium on new licenses for Alzheimer’s/dementia special-care units |
| No mention | Creates exemption in the state’s Certificate of Need law for replacement of equipment and facilities on the main campus of a hospital; exempts facilities from having to file paperwork with the state to replace equipment that costs more than $2 million threshold | Creates exemption in the state’s Certificate of Need law for replacement of equipment and facilities on the main campus of a hospital; exempts facilities from having to file paperwork with the state to replace equipment that costs more than $2 million threshold |
| Similar language that passed the House in the form of House Bill 492 was incorporated into Senate budget | Sets criteria for Medicaid patients in their own homes or in adult care homes with disabilities to receive personal care services for up to 80 hours. Patients must need hands-on help with eating, dressing, bathing, toileting and mobility. Patients are eligible for an additional 50 hours of personal care services if they need increased supervision, have a memory problem such as dementia or Alzheimer’s, require a safe physical environment, exhibit safety concerns. Personal care cannot include babysitting, coaching, prompting, guiding, coaching, babysitting, transportation or financial management. A doctor must attest to the above |
House Bill 492 was signed into law by Gov. McCrory on July 18. Sets criteria for Medicaid patients in their own homes or in adult care homes with disabilities to receive personal care services for up to 80 hours. |
| Modifies funding for the Office of Administrative Hearings and changes procedures for contesting care and payment decisions made by Medicaid officials; sets out procedure for withholding payment to a Medicaid provider that has an identified overpayment | Modifies funding for the Office of Administrative Hearings and changes procedures for contesting care and payment decisions made by Medicaid officials; sets out procedure for withholding payment to a Medicaid provider that has an identified overpayment | Allocates $1 million for FY 2013-14 and $1 million for FY 2014-15 to the Office of Administrative Hearings for mediation services to solve Medicaid appeals; specifies that Medicaid will not pay the contractor performing the audit until all of the appeals have been exhausted |
| Sets out procedure for withholding payment around a Medicaid provider that is being audited; specifies that Medicaid will not pay the contractor performing the audit until all of the appeals have been exhausted | Sets out procedure for withholding payment around a Medicaid provider that is being audited; specifies that Medicaid will not pay the contractor performing the audit until all of the appeals have been exhausted | Senate Bill 553, which creates new procedures for grievances and appeals, is still pending. It failed a concurrence vote in the Senate and remains stuck due to differences between the House and Senate on some provisions of the bill. |
| Sets out a requirement that Medicaid service providers purchase a performance bond of no more than $100,000 (depending on level of billing). The bond may be called if the provider has a financial failure or is found participating in fraud or abuse. The bond requirement can be waived for providers in good standing, with low billings and showing good record keeping, or if the service provided is essential for access to care for local Medicaid recipients. | Sets out a requirement that Medicaid service providers purchase a performance bond of no more than $100,000 (depending on level of billing). The bond may be called if the provider has a financial failure or is found participating in fraud or abuse. The bond requirement can be waived for providers in good standing, with low billings and showing good record keeping, or if the service provided is essential for access to care for local Medicaid recipients. | Sets out a requirement that Medicaid service providers purchase a performance bond of no more than $100,000 (depending on level of billing). The bond may be called if the provider has a financial failure or is found participating in fraud or abuse. The bond requirement can be waived for providers in good standing, with low billings and showing good record keeping, or if the service provided is essential for access to care for local Medicaid recipients. |
| Creates a shared savings program, wherein DHHS will withhold 2% of Medicaid payments to doctors, hospitals, dentists, drugs, personal care services, chiropractors, podiatrists, nursing homes, adult care homes, opticians and optical suppliers and hearing-aid providers, with payments being paid back to the providers starting June 2014 if those providers save Medicaid dollars | Creates a shared savings program, wherein DHHS will withhold 4% of Medicaid payments to doctors, hospitals, dentists, drugs, personal care services, chiropractors, podiatrists, nursing homes, adult care homes, opticians and optical suppliers and hearing-aid providers, with payments being paid back to the providers starting Jan, 2015 if those providers save Medicaid dollars | Creates a shared savings program, wherein DHHS will withhold 3% of Medicaid payments to doctors, hospitals, dentists, drugs, personal care services, chiropractors, podiatrists, nursing homes, adult care homes, opticians and optical suppliers and hearing-aid providers, with payments being paid back to the providers starting Jan, 2015 if those providers save Medicaid dollars |
| The 3% withheld from the Medicaid pharmaceutical costs will be used to create a program for Medcaid and Health Choice beneficiaries, similar to CheckMeds, a program that helps seniors manage their medications better | ||
| Changes assessment levied on hospitals that care for Medicaid payments from a set statewide fee of $43 million to a statewide fee of $95 million | Changes assessment levied on hospitals that care for Medicaid payments from a set statewide fee of $43 million to 15.6% of Medicaid revenue | Changes assessment levied on hospitals that care for Medicaid payments to 25.9% of Medicaid revenue. The NC Hospital Association estimates the total collected from this assessment will be about $52 million. |
| Changes the way the state Medicaid program pays for hospital care, setting three regional rates to be adhered to by all hospitals in a region | Changes the way the state Medicaid program pays for hospital care, setting three regional rates to be adhered to by all hospitals in a region | Changes the way the state Medicaid program pays for hospital care, setting four regional rates to be adhered to by all hospitals in that region |
| For hospitals newly acquired by another hospital system after Dec 2011, rates remain at the purchased hospital’s old rate | For hospitals newly acquired by another hospital system after Dec 2011, rates remain at the purchased hospital’s old rate | For hospitals newly acquired by another hospital system after Dec 2011, rates remain at the purchased hospital’s old rate |
| Requires a cost-effectiveness and outcomes study done on Community Care of North Carolina, the state’s medicaid care management organization | Requires a cost-effectiveness and outcomes study done on Community Care of North Carolina, the state’s medicaid care management organization | Requires a cost-effectiveness and outcomes study done on Community Care of North Carolina, the state’s medicaid care management organization |
| Sets a monthly incentive payment to CCNC for good performance | Sets a monthly incentive payment to CCNC for good performance | Sets a monthly incentive payment to CCNC for good performance |
| Study allowing certified nurse midwives greater flexibility in their practice, to consider whether CNMs should be allowed to practice midwifery in collaboration rather than under supervision of physicians | No mention of midwives | Study allowing certified nurse midwives greater flexibility in their practice, to consider whether CNMs should be allowed to practice midwifery in collaboration rather than under supervision of physicians |
| No mention of NC Institute of Medicine | Changes make-up of NC Institute of Medicine board of directors | No mention of NC Institute of Medicine |
| Pre-K | Pre-K | Pre-K |
| Qualifications: children with family income below 130% FPL (~$29,055 for family of four in 2012), active duty military parent killed during military activity, other eligibility determinations via LEAs and Smart Start local partnerships |
Qualifications: children with family income below 75% of state median income (~ $50,975 for 4-person household in 2012), active duty military, parent killed during military activity, other eligibility determinations via LEAs and Smart Start local partnerships. Other than developmental disabilities or other chronic health issues, division shall not consider health of the child in eligibility determination. |
Qualifications: children with family income below 75% of state median income (~ $50,975 for 4-person household in 2012), active duty military, parent killed during military activity, other eligibility determinations via local education administrations and Smart Start local partnerships. Other than developmental disabilities or other chronic health issues, division shall not consider health of the child in eligibility determination. |
| County DSS administrative allowance for child care subsidy = 3% or $80,000 (whichever is greater), for a reduction of $5.1M over two years | County DSS administrative allowance for child care subsidy = 4% or $80,000 (whichever is greater) | County DSS administrative allowance for child care subsidy = 4% or $80,000 (whichever is greater) |
| Allows county DSSs to take additional 2% administrative costs out of allocation to do fraud detection | Allows county DSSs to take additional 2% administrative costs out of allocation to do fraud detection | |
| Adds 5,000 Pre-K slots at the lower eligibility | Keeps higher eligibility, but eliminates 2,500 Pre-K slots in the first FY and 5,000 slots in the second FY | Adds 2,500 Pre-K slots at the higher eligibility. This replaces one-time funding that provided for 5,000 slots = net loss of 2,500 slots. |
| Adds $24.8 million in funding each year, coming from the state lottery receipts. (NC Pre-K has traditionally been funded by state general fund & lottery receipts.) | Cuts $12.4 million in FY 2013-14 and $24.9 million in 2014-15 from Pre-K and transfers this money to child care subsidies (below) | Allows $12.4 million from lottery receipts to fund the added slots. Brings total of slots to 27,500. |
| Reduces the waiting list by tightening eligibility | Creates more of a waiting list while maintaining wide eligibility | There will still be waiting list that will go up slightly because of the loss of 2,500 slots |
| Leaves Smart Start funding in place at $146 million of state dollars | Committee language states budget moves about 42% of Smart Start funding to county DSS programs in order to add to child care subsidies; total allocation ~$84.6 million (see below) | No change in the Smart Start budget allocation in this budget |
| Increases percentage Smart Start local partnerships have to match to state dollars from 13% to 15% over 2 years | Increases percentage Smart Start local partnerships have to match to state dollars from 13% to 15% over 2 years | Increases percentage Smart Start local partnerships have to match to state dollars from 13% in FY 2013-14 to 15% in FY 2014-15 |
| Child care program similar language to Senate | Child care program similar language to House | Child care program similar language to House |
| Keeps child care subsidies essentially the same | Adds $9.8 million in FY 2013-14 and $22.2 million in FY 2014-15, a total of $5.3 million less than what was cut from NC Pre-K | Keeps child care subsidies essentially the same as last year. No money transfers to or from the CC Subsidy program. |
| Takes money from both Smart Start and from Pre-K and puts into child care subsidies to be administered by local county Departments of Social Services | Local partnerships will continue to administer parts of the state’s child care program | |
| Waiting list is currently about 40,000 | Waiting list reduced from about 40,000 by 2,500-3,000 children | 2,500 newly funded recurring slots will reduce waiting list |
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