Senate leaders are looking at major cuts to health and human services programs that serve the poor, disabled and elderly in order to pay for teacher raises and fund Medicaid to required levels.
The North Carolina chapter of the AARP  has a good rundown here  on what some of the proposed cuts will do, and the group says it is “disheartened to see the Senate budget proposal doesn’t value our state’s older adults and those who are blind and disabled.”
The state’s doctors are also concerned about the cuts to Medicaid system, and how it will affect some of the most vulnerable North Carolinians.
Robert Seligson, the head of N.C. Medical Society, denounced the state Senate’s budget proposal Thursday, saying it offers “no solution to the big challenges we’re facing in Medicaid.”
“Patient care under the Senate plan will suffer, especially for the aged, blind and disabled citizens of our state, who will no longer be eligible for Medicaid if the Senate has its way,” Seligson said in a statement.
Republican Senate leaders also said they planned to seeking major changes to the administration of the state’s Medicaid system in coming years, and set aside $5 million in the state budget beginning in July to explore moving the $13 billion program to a new entity outside of DHHS.
Medicaid, a mandated federal program that provides health care for impoverished elderly, children and disabled residents is funded with both state and federal dollars and is the one of the state’s biggest expenditures.
Senate Republicans expressed their disapproval Thursday morning of the Medicaid reform proposal put forth earlier this year by DHHS Secretary Aldona Wos.
“We are going to form an independent program to run Medicaid,” said state Sen. Louis Pate , a Mount Olive Republican.
Among the most significant changes proposed in the Senate budget released late Wednesday night are:
- Removal of approximately 12,000 elderly, blind and disabled people from automatic Medicaid eligibility who received special state assistance. The $28.8 million in cuts lowers North Carolina’s coverage for the vulnerable population to the federal poverty line (incomes under $12,000 for one person, $23,850 for family of four)
- Cuts another 3,342 people deemed to be “medially needy” from Medicaid rolls because it is not a federal requirement. Anticipates $3.5 million in savings.
- A nearly $1 million cut to the Home and Community Care Block Grant  program that offers in-home services to impoverished elderly residents. The program, which pays for home health aides and meal deliveries, currently has a wait list of 16,000 people, according to AARP. 
- Reiterates legislative desire for DHHS to close four of the 16 early-intervention offices (called child development service agencies) by January for disabled infants and toddlers. For background on that issue, and how a DHHS plan to shut three offices in Eastern North Carolina derailed this spring, click here 
- Cuts state funding for school nurses by 29 percent, eliminates 70 positions and redirects the remaining 166 school nurse slots to the state’s poorest counties (known as Tier 1 counties). Most school nurse slots in the state are funded through local education dollars after several years of state-level cuts.
- Narrows the pool of families eligible for child-care subsidies by tightening income eligibility but also shifts funding to take 5,500 children off of waiting lists into day cares.
Other significant cuts for the N.C. Department of Health and Human Services are an elimination of $16 million in vacant slots and contracts across the agency, the state’s largest. The agency has experience high turnover in administrative positions under Wos, in addition to the routine turnover of nurses, doctors and other health practitioners at the state’s hospitals.
It’s unclear how those $16 million in reduced funding would play out, but would certainly have a big impact on already stretched workloads of existing agency staff.
The Senate budget for DHHS does increase to the state’s foster care and child welfare divisions after several high-profile incidents brought attention to funding and caseload issues faced by county-based workers tasked with protecting children.
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