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MedicaidThere’s new and compelling evidence that North Carolina’s model for delivering Medicaid (Community Care North Carolina -CCNC) is a winner — notwithstanding the often-bumbling oversight provided by embattled state DHHS Secretary Aldona Wos and the attempt by Senate leaders to sell the program off to a private managed care company. (It’s worth noting that the flawed sell-off idea was once also touted by Gov. McCrory and Sec. Wos as well until the two gradually came to their senses over the past year).

Today, in a letter to state Medicaid directors throughout the country, the Centers for Medicare and Medicaid Services at the national DHHS announced today that they are launching a new national collaborative initiative called the “Medicaid Innovation Accleerator Program.” The goal of initiative is “to improve care and improve health for Medicaid beneficiaries and reduce costs by supporting states in accelerating new payment and service delivery reforms.”

The letter announcing the initiative holds up three examples of state innovation success in Ohio, Washington and North Carolina. Here’s what it has to say about North Carolina: Read More

NC GearA friend of NC Policy Watch points out that a new and controversial $4 million McCrory administration program to fight inefficiency in state government may itself be an example of inefficiency and redundancy.

As WRAL reported earlier this week, the head of the NC Government Efficiency And Reform initiative (NC GEAR) — a former John Locke Foundation staffer — got a fairly skeptical reception at a joint legislative committee on Monday.  Senators and representatives both voiced concern that $4 million was a lot to spend on an ill-defined initiative that has thus far produced very little of substance.

Even, however, if one sets aside the output from NC GEAR thus far (i.e. not much), it’s also worth noting that North Carolina already has a similar program in place called NC Thinks.

Thus far, the main evident function on the NC GEAR website is a virtual suggestion box for improving government efficiency. But, as a our friend points out, NC Thinks already does that!

Here is the website description for that initiative: Read More

A new report from the experts at the N.C. Budget and Tax Center paints a sobering picture of what the new “recovered” North Carolina economy really means for average people:

“North Carolina’s recovery from the Great Recession has been marked by slow job growth and persistent challenges for working families to make ends meet. The minimal job growth has been concentrated in low-wage industries, a new report finds, which will only make North Carolina’s economic recovery that much more difficult. Read More

State Senate leaders are unveiling their approach today to cleaning up the state’s hazardous coal-ash ponds, but a leading environmental group is already saying new legislation doesn’t go far enough.

The proposal will be discussed at a 3 p.m. committee hearing in Raleigh at the N.C. General Assembly.

The AP first reported last night that the Senate proposal (click here to read) would require Duke Energy to close its coal-ash dumps within 15 years, and WRAL had this wrap-up as well and a summary to the Senate proposal here.

Coal ash from February spill near the Dan River

Coal ash from February spill near the Dan River

But Frank Holleman, the attorney steering the Southern Environmental Law Center’s litigation over coal ash, said the Senate bill still defers many of the decisions to the N.C. Department of Environment and Natural Resources. That, he said, could mean that Duke Energy could continue to get passes on cleaning up the toxic by-products found in 33 unlined pits at the electricity utility’s 14 coal-fired plants in the state.

All the pits have contaminated nearby groundwater, and environmental groups have criticized DENR’s reluctance before the February coal ash spill in the Dan River to demand cleanup.

“What North Carolina needs but is not done in this bill is a direct requirement that Duke clean up its coal ash,” Holleman said. “It leaves it to the failed state agency.”

Read More

New_York_City_Gridlock

The House budget includes a requirement that the position of Medicaid Director be subject to confirmation by the North Carolina General Assembly. Here’s some of the language:

4         APPOINTMENT AND CONFIRMATION OF MEDICAID DIRECTOR
5         SECTION 12H.36.(a) Effective July 1, 2014, and applying to Directors of the
6         Division of Medical Services appointed on or after that date, G.S. 108A-54 is amended by
7         adding a new subsection to read:
8         “§ 108A-54. Authorization of Medical Assistance Program; administration.
9         …
10       (e) The Medicaid Program shall be managed by the Director of the Division of Medical
11       Assistance (Medicaid Director), who shall be recommended by the Secretary of Health and
12       Human Services and appointed by the Governor, subject to confirmation by the General
13       Assembly by joint resolution. [...]

This provision should raise many questions and concerns. The legislature does not have appointment authority over any other position that is so central to carrying out the policy agenda of the Governor. If, for example, the legislature is bent on limiting access to Medicaid while the Governor wants to streamline enrollment, then the conflict will likely shut down any ability to get a Medicaid Director in place.

And while there is a clear process to appoint a Director if the Governor does not forward a nomination, the budget does not spell out what happens if the legislature refuses every nominee from the Governor. What would most likely occur is that the Governor would have to wait until the legislature is out of session and then appoint a temporary Medicaid Director.

If all of this sounds familiar it’s because this is how the process works in Washington, DC, where politics clouds every decision and ties up the basic functions of government. Instead of fostering bi-partisanship and stability, Congress has caused major disruptions in the running of Medicare and Medicaid by refusing to approve presidential nominees.

The same is likely to happen in Raleigh.

The Governor, who is elected statewide, should be able to appoint his or her preferred Medicaid Director to carry out the policies that he or she was elected to enact. If this confirmation requirement survives negotiations between the House and the Senate then leadership elected in select pockets of the state will have veto power over how the Governor runs one of the most important agencies of the executive branch.