Today’s headlines  highlight a audit of the state Medicaid program that shows an over $1 billion shortfall. “Shocked, shocked, I tell you!” are Republican Governor Pat McCrory and DHHS Secretary Aldona Wos that the Medicaid agency did not meet its budget:
Dr. Aldona Wos, secretary of the state Department of Health and Human Services, said at the news conference that the agency will change the way it operates. “Cost overruns will not be tolerated and will not be acceptable,” she said. “There’s a budget for a reason.”
But the major finding in the audit, the one that has gotten all the headlines, that NC’s Medicaid program wasn’t able to meet the budget set for it by the Republican majority in the General Assembly (and passed over former Democratic Governor Perdue’s veto) shouldn’t be a surprise to anyone. As former DHHS Secretary Lanier Cansler said on August 4, 2011 :
“It’s just really going to be next to impossible to achieve this budget, and I’m not sure where the legislature will go with that,” Cansler said. “The fact that this budget plays into next year (means next year) is going to be a difficult budget year as well.”
Secretary Cansler pointed out in a letter sent directly to Republican General Assembly leaders  again on October 27, 2011:
…aggressive budget cuts mandated by the General Assembly’s budget are unreasonable and unobtainable.
Of course, despite demanding massive Medicaid cuts, Republican General Assembly members further tied Secretary Cansler’s hands  in January 2012 when the prospect of politically harrowing cuts in so-called “optional” services like artificial limbs and cuts in payments to doctors and hospitals were on the table:
The Legislature told Cansler neither to reduce rates drastically for doctors who provide medical services nor scale back optional Medicaid services to close the gap.
Overall, sure, when a health program like Medicaid has had its administrative costs cut to the bone there are going to be reforms that can be made. They may take hiring more administrators however! But for the McCrory Administration to express shock – and the state auditor to completely ignore – the fact that warning after warning was given to the Republican General Assembly and anyone else who would listen over the last year and a half that the NC Medicaid program would not be able to meet the unrealistic budget set for it by the NC General Assembly is disingenuous at best.