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Medicaid program staff released updated estimates of the current year’s Medicaid state funding shortfall as well as their estimate of next year’s shortfall at the monthly meeting of the Medical Care Advisory Committee. As has been reported elsewhere, the recent court order reinstating coverage of personal care services for adults with disabilities, the Division of Medical Assistance added $9.4 million in estimated expenses into the current year’s budget, driving the current year shortfall up to $149 million.

Next year’s estimated shortfall of $243 million will be driven by many of the same factors that created this year’s problem, according to DMA Chief Business Operating Officer Steve Owen. Read More

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. Read More

The American Jobs Act of 2011 includes both a tax credit and a programmatic directive intended to alleviate higher-than-average unemployment rates for veterans. There is no question that policymakers should take decisive and direct action to alleviate the high rate of unemployment among veterans. In September, unemployment among veterans of Iraq and Afghanistan was higher (11.1 percent) than the rate for non-veterans (8.6 percent).  Additionally, 21 percent of veterans of Iraq and Afghanistan report having a service-connected disabilityalmost twice the rate of reported service-connected disabilities for living veterans across all eras, both war and peacetime. While the effectiveness of the enhanced existing tax credit for hiring unemployed veterans is doubtful, the Act’s programmatic directive to assist veterans with job training and placement is promising. However, independent of the federal actions proposed in the Jobs Act, it is entirely possible for states to legislate civilian recognition of veterans’ military training and expertise in the form of professional credentials and certifications, with the result of leveling the playing field for skilled veterans competing for employment in the civilian labor market. Read More

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During the recent legislative session, the NC Budget and Tax Center and others expressed doubts about the feasibility of enacting $359 million in Medicaid cuts in the first year of the biennium – concerns which were echoed in a letter sent by Gov. Perdue to legislative leaders prior to passage of the FY11-13 biennium budget. In a meeting of the Joint Legislative Oversight Committee for Health and Human Services yesterday, NC Department of Health and Human Services Secretary Lanier Cansler reported that there is a $100 million “hole” in the Medicaid budget attributable to various programmatic and administrative issues, of which the largest single piece is a $30 to $40 million shortfall due to delays in program change authorizations from the federal government. Read More

North Carolina’s Medical Care Advisory Committee (MCAC) met at NC State University this morning at the behest of Gov. Perdue and DHHS Secretary Lanier Cansler to discuss how the agency will implement the legislative budget’s unprecedentedly deep cuts to the Medicaid program. Members of the committee have been asked to work with DHHS leadership and staff to determine how best to further cut the state’s share of Medicaid spending while upholding the department’s Division of Medical Assistance (DMA) commitment to “us(e) the power of the Medicaid program to improve the standard of care across North Carolina.”

Unfortunately for members of the committee, many of whom are themselves direct care providers, there’s clearly no way to meet the budget requirements set forth by the legislature without eliminating Medicaid services that are known to improve health outcomes while saving money, like adult dental care and community-based mental health services. Read More