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Since assuming office Gov. McCrory has throttled the theme that Medicaid is broken and must be reformed. He began by offering a radical proposal of dismantling our current system and selling it off to private insurance plans. He has since backed away from that idea and now wants a more modest expansion of what currently works in Medicaid.

The House, in a bipartisan bill filed this session, clearly agrees with the Governor’s new approach. The legislation, spearheaded by Rep. Nelson Dollar, would build Accountable Care Organizations (or ACOs)  in Medicaid. These provider led ACOs would move us toward greater integration of care and away from fee-for-service medicine. Medicare is using the ACO model as are many private insurers. In fact, Medicaid is one of the only payers in the state not moving to this method of organizing care.

In its budget, the Senate flatly rejects this approach. That chamber wants Medicaid to move to full capitation. In other words, legislators want to provide a set budget to Medicaid. The insinuation is that the Senate prefers the Governor’s original plan to pay private insurers to care (or not care, as the case may be) for our most vulnerable citizens.

The Senate also engages in some fantasy by pulling Medicaid into a freestanding department that will engage the nation’s best health care minds in this ambitious reform effort. At least that’s how Sen. Louis Pate described the proposed process. The trouble, of course, is that the nation’s best health care minds consider North Carolina’s Medicaid program to be an important model and they aren’t interested in helping to dismember it. The nation’s best health care minds also aren’t interested in coming to our state and spending time tearing apart care for low-income people as the legislature reduces services, limits eligibility, and slashes the budget. We are, in short, engaged in the opposite of innovation.

Rep. Dollar is a smart chap and likely realizes that his ACO bill isn’t going anywhere as a piece of legislation. That means he will need to stick the proposal into the House budget to give it a fighting chance. Hence, the showdown mentioned in the title of this post.

Certainly the House is moving in a better direction. But it’s a good time to reflect that Virginia is having its own budget battle over Medicaid right now. Except instead of fighting over how to fiddle with (or blow up) a program that is working, Virginia’s leaders are having a serious discussion about using federal funds to expand Medicaid coverage to 400,000 people. If that happens it means that our tax dollars will help boost Virginia’s economy, bolster its rural hospitals, and support its citizens.

That will certainly be charitable of us, but not wise.

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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.

DHHSThe 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.

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The U.S. Department of Agriculture announced yesterday that North Carolina health officials successfully cleared a backlog of food stamps cases that had been in the tens of thousands last year following issues with a statewide technology system.

At stake was $88 million in federal funding, which USDA, which oversees the national SNAP (Supplemental Nutrition Assistance Program), said it would consider rescinding if the N.C. Department of Health and Human Services didn’t quickly clear the backlog.

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The N.C. Department of Health and Human Services released a statement Tuesday saying it believed the agency “reasonably achieved” a deadline to clear the state’s backlog of pending food stamp cases.

DHHS Sec. Aldona Wos

DHHS Sec. Aldona Wos

N.C. Health and Human Services Secretary Aldona Wos  wrote in a letter Tuesday to USDA Regional Director Robin Bailey that the backlog was down to 375 cases, including in Guilford County where a previously unknown backlog of 8,100 cases was discovered last week.

“We have made tremendous efforts to meet the March 31, 2014 deadline and have implemented strategies to ensure that the workload requirements are met and families will receive timely benefits,” Wos wrote.

The state had seen backlog grow to as high as 20,000 to 30,000 food stamp cases with families waiting for weeks and months following the troubled launch last year of a new online-based benefits delivery system  called N.C. FAST.

USDA, which oversees the nation’s food stamps, or SNAP (Supplemental Nutrition Assistance Program) called the delays in North Carolina “unacceptable” and threatened in December and January to rescind $88 million in federal funding if the state didn’t quickly clear the backlog.

Check back with N.C. Policy Watch tomorrow, where we’ll have a more extensive article about the food stamps backlog, new budget concerns and interviews with some affected families.

Click here to read Wos letter. You can see pending  caseload data here and here.

Usda April 1 2014 by NC Policy Watch

 

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From the good people at UE local 150, N.C. Public Service Workers Union:

UE 150 protestA new report released by UE local 150, N.C. Public Service Workers Union highlights the need for ‘Safety, Rights and Raises’ for state DHHS employees.  The report details new information about horrible understaffing, vacant positions not being filled,  alarming turnover rates, along with Department of Labor wage data showing how far behind state employees are with their salaries.

DHHS employees, all members of UE local 150, N.C. Public Service Workers Union from Cherry Hospital, Caswell Developmental Center, Central Regional Hospital and Murdoch Center but representing workers in all state operated facilities, met with DHHS Sec. Wos and her administration yesterday.

‘We are glad that Sec. Wos is committed to continue to dialogue with workers, ‘ stated Regina Washington, developmental technician from Caswell Center. ‘However we are upset by her insistence that certain upper classes of workers deserve raises compared to direct care staff, who are the lowest paid and who receive the bulk of the injuries and stress. ‘ Read More