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In a good conversation with Becki Gray yesterday on News 14 we discussed the different visions for Medicaid reform proposed in the respective budgets of the Governor, House, and Senate. In particular, Gray, who works for the John Locke Foundation, noted that the state has a “rich” benefits package in Medicaid because we offer many optional services, that is, services that are not required to be covered by the federal government. The Senate, she correctly pointed out, wants to whittle away these optional services.

Ending optional services in Medicaid is a popular policy among conservative think tanks in the state. Apparently the Senate is listening.

As this debate progresses it is important that we know what services we are talking about when we talk about optional services. Let’s review a few: transplants, prescription drugs, dentures, hospice, prosthetics. None of these treatments are frivolous or lavish.

And that’s the trouble with optional services. If you want to get at some of the more expensive options then you are limiting life-saving care. Former Locke Foundation analyst Joe Colletti even praised Arizona for cutting optional services like transplants in a report on Medicaid reform. But these cuts inflicted so much pain in Arizona that the state made a volte-face on its decision.

That brings us to the Senate budget. Among other things the Senate wants to end the optional Medically Needy program in Medicaid. This program allows people who have enormous medical expenses, but earn too much to qualify for Medicaid, to apply these medical bills to their income to access Medicaid. This makes sense. If, for example, you earn $30,000 per year but need expensive drugs or nursing home care then these costs will quickly eat through your monthly income. Although you may have some money your medical needs erase it all. It’s not fair to tell this person that he or she is too wealthy for Medicaid when they effectively have nothing.

But this is exactly what the Senate aims to do.

As we have said many times before, “optional” refers to a regulatory requirement and does not mean anything about the necessity or quality of specific Medicaid services. You may call it foolish for the state to cover optional services. I call it basic human decency.

 

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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.

Jim Lind is a decorated US Air Force vet and a software development professional who’s done it all over a 39-year career: managing and developing for commercial industries, for the military, for education systems, for space systems, you name it.

He’s also been unemployed since early 2009 when the Great Recession resulted in major layoffs at his and so many other workplaces. When Jim finally found work for a contractor for Amtrak, the sequester cut that short just 10 weeks into the job.WP_20140220_005-edit-600-web

Jim was one of eight unemployed professionals who met with U.S. Rep. David Price and Wake Tech President Stephen Scott last week to explain the human toll exacted by North Carolina’s reckless changes to its unemployment insurance program, detailed by a recent Budget and Tax Center report on the issue. They also spoke about how important the programs at the community college have been for them.

“The reason I am here is to talk about who the unemployed are. Who are we really. Myths are not helpful for becoming re-employed,” he said.

Jim explained that the federal extensions of unemployment at a higher weekly rate than is available now were a life saver for him, providing the most basic assistance to eat and pay some bills.

“I had to count slices of bread, eggs in the fridge, measure things in ounces, plan when to wash my clothes in order to be able to pay the rent where I was living,” he said. Plus, even looking for work in today’s world requires expensive tools like a cell phone, an Internet connection and computer, a car. “I don’t know how cutting people off…is helpful for people finding work.” Read More

ICYMI, the lead editorial in the Charlotte Observer is a good one. It explains — much as NC Policy Watch Courts and Law reporter Sharon McCloskey did in this story yesterday — why the claims of legislative leaders of that “legislative immunity” somehow insulates them from disclosing the real reasons behind the voter suppression bill passed last session are completely bogus. After exploring the recent hubbub surrounding the bizarre comments of Senator Bill Rabon in the puppy mill controversy, the editorial puts it this way:

“The legislators say they are protected by ‘legislative immunity,’ which they claim not only shields them from ‘arrest or civil process for what they do in legislative proceedings,’ but also having to reveal the conversations they had during the crafting of that legislation.

Are they right? Read More

The board of governors for the 17-campus University of North Carolina system will decide next month if it wants to freeze in-state tuition and reject some of the tuition increases the legislature mandated for out-of-state students in this year’s budget.

Click here for a detailed overview in the News & Observer of the tuition proposal.

The UNC Board of Governors, who discussed the proposals at a meeting Thursday, will also vote on system-wide2014-15 budget recommendations (click here to see) at their meeting next month, on Feb. 21. The proposal also seeks to reverse an estimated $7.8 million in discretionary cuts called for by the legislature.

Tom Ross, the UNC system president, spoke with reporters after Friday morning’s meeting, said  continual cuts to the university system isn’t sustainable.

“What’s the breaking point when it begins to affect quality?,” Ross asked. “There are times now that we’re hearing from students that they can’t get the course they need. We have to be sure we’re protecting quality as well.”   Read More