Tallying up the Medicaid shortfall
Today before a meeting of the Joint Legislative Oversight Committee on Governmental Operations, the NC Department of Health and Human Services testified on their progress to date implementing the $356 million budget cut to the state’s Medicaid program. As reported in the N&O, state efforts to comply with the General Assembly’s scaled-back vision of health care for eligible children and adults have run into the wall of federal program mandates (i.e., you can’t cut eligibility for Medicaid under federal law, you can’t cut medically necessary services for children, etc.), administrative delays on changes to the program, and even a shortsighted cut to a relatively small line item that would have resulted in the state paying three to four times as much for a necessary item due to loss of federal matching funds. Given these factors, DHHS projects ending the current fiscal year $139 million over budget – or, for the budget hawks out there, 4.7% over the Division of Medical Assistance’s total budget target.
Here is the Budget and Tax Center breakdown of details on the Medicaid budget shortfall as they were provided by DHHS to the committee this morning, starting with unbudgeted liabilities and receipts, then moving on to budget shortfalls.
Moving on, DHHS detailed their projected shortfalls from currently budgeted “savings” targets:
When the net unbudgeted liabilities and receipts are added to total current year projected shortfalls, you get $148 million in Medicaid outlays over budget for the year, which is about 5 percent over their total authorized budget. What DHHS presented today was in no sense as detailed as their own accounting records, which likely explains the $9 million difference between this total and their own projected $139 million shortfall, but in the big scheme of things the difference between these two amounts is a tiny fraction of the total Medicaid budget – 0.3 percent, to be exact.
Now that DHHS has laid their cards on the table, it’s up to lawmakers to decide how to bridge the gap without hollowing out health care for children, people with disabilities, and the elderly.