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well-timed tissueGov. McCrory may have shed a few tears yesterday over the departure of his Secretary of Health and Human Services, Aldona Wos, but the chief reaction across the state — both within government and without — was relief and a strong feeling of “what took so you long? This morning’s editorial pages tell the story:

Here’s Wos’ hometown Greensboro News & Record in an editorial called “Good heart, bad fit”:

“As for tangible results, well, that was another matter. Despite her background as a physician and former U.S. ambassador— and her famous, sunrise-to-late-night work ethic — the sheer weight of the DHHS bureaucracy seemed to overwhelm Wos.

In time, critics on both sides of the partisan aisle began to wonder out loud if they were getting their money’s worth.

Now, after two and half years at the post, Wos is leaving, Gov. Pat McCrory announced at a Wednesday news conference in Raleigh. Standing at his side, Wos noted it was ‘time to go home.’ Although the governor tearfully praised Wos’ job performance and commitment — as he has all along — her tenure has been wracked by a series of missteps and crises, large and small…”

The N&R then goes on to list a half dozen HHS disasters under Wos’ leadership.

Raleigh’s N&O put it this way in a piece entitled “Don’t cry for me North Carolina”:

“Some Republican lawmakers were annoyed by the turmoil in the department and Wos’ inability to provide reliable numbers on the cost of Medicaid. Senate Republicans even proposed that their version of Medicaid reform would remove the program entirely from DHHS and place its management under the control of a new agency. Indeed, lawmakers doubts about Wos may well have played a role in her resignation.”

The Winston-Salem Journal called for the department to be put back on track:

“The resignation Wednesday of Dr. Aldona Wos, the embattled secretary of the state Department of Health and Human Services, was as overdue as it was unsurprising.…During the two-and-a-half years she has served as secretary, legislators of both parties, advocates and state audits have repeatedly pointed out flaws in the department’s delivery of service to some of our most vulnerable citizens.”

Charlotte Observer cartoonist Kevin Siers compares the department Wos leaves behind to the Statue of Liberty — the torch section.

Meanwhile, the Fayeteville Observer took a different approach, noting that Wos’ departure provides a perfect time to expand Medicaid:

“When he explained why he declined to adopt Obamacare’s expanded Medicaid coverage two years ago, Gov. Pat McCrory said he couldn’t do it because the system was broken. Two consecutive years into positive fund balances, it doesn’t look broken anymore, does it? Where, then, is the expansion initiative, which would bring billions of federal dollars to North Carolina, insure hundreds of thousands of residents without coverage and likely save some rural hospitals from shutting down?”

Commentary

Medicaid expansionFor years now, poor and working North Carolinians who would benefit greatly from Medicaid expansion under the Affordable Care Act have been held hostage as Governor McCrory procrastinated and offered excuses. First, the Guv claimed that the Medicaid system itself was “broken” and in need of repair before it could be expanded. Then, he claimed that it would be inappropriate to act until the U.S. Supreme Court ruled on the constitutionality of the ACA itself.

Today, McCrory is running out of excuses. The Supreme Court took care of the constitutionality question a few weeks ago and yesterday, McCrory himself laid Excuse #1 to rest.

According to a statement from the Governor’s office, Medicaid is now in the black:

“The Department of Health and Human Services reported today that the North Carolina Medicaid program ended the 2014-15 state fiscal year with $130.7 million cash on hand. This is the second consecutive year the Medicaid program has finished with cash on hand.”

What’s more, that surplus is more than enough to cover state costs of implementing expansion. As a December 2014 study from health policy wonks at the Milken Institute School of Public Health at George Washington University reported (see page 15), expansion will actually save the state more than $300 million over the next five years. In 2020, however, there will be a modest net cost to the state of $91.7 million.

The obvious takeaway? Even if the state flushed away the savings that expansion will bring between now and 2020, it can easily cover the modest bump in costs in 2020 merely by socking away the current surplus.

Not surprisingly, however, the Guv is already moving the goalposts. Read More

News

Earlier this week, health care advocates across the nation marked a milestone: the 50th anniversary of the Medicaid and Medicare programs.

To mark the occasion, the good folks at North Carolina Health News have put together a useful interactive map, demonstrating how Medicaid benefits the residents of each county in our state.

Here’s a snapshot of how the program benefits Rockingham County, the home county of Senate President Phil Berger:

nchealthnewsmapClick here (and scroll down) to view the full map and read more about how Medicaid provides lifesaving health care to the most vulnerable people in North Carolina.

This weekend, NC Policy Watch will discuss Medicaid expansion on its weekly radio show, News & Views with Chris Fitzsimon.

Joining Chris will be Joan Alker, the executive director of Georgetown University’s Center for Children and Families.

Alker discusses CCF’s new report on how parents and kids benefit from closing North Carolina’s Medicaid coverage gap.  (CCF recently traveled to North Carolina to release the report in partnership with NC Child and the NC Health Access Coalition.)

Below Alker talks about why Governor Pat McCrory is overdue in presenting  a state-specific plan for Medicaid expansion:

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News

Robeson County officials settled a complaint with the federal justice department this week, saying it would take steps to improve access for disabled residents to public resources.

The federal agency had found the county had numerous violations of the Americans with Disabilities Act (which was passed 25 years ago) , leaving those with disabilities unable to access county services and programs as easily as other citizens.

A news release from the U.S. Justice Department about the settlement noted that Robeson County, on North Carolina’s border with South Carolina, has a poverty rate of over 30 percent, and nearly 40 percent of its population identities as Native American, and 25 percent are African-American.

According to the settlement, the county agreed to make changes to buildings and county property so that parking, building entrances, restrooms, service counters and drinking fountains can be accessed by those with physical disabilities. The sheriff’s office will also have to devise a plan so that its deputies and emergency responders can communicate with those who are deaf or hard-of-hearing, and accommodations will be made at voting sites so that those that use wheelchairs or who are blind or with vision issues can cast votes without hindrances.

The settlement comes the same week the N.C. Auditor’s Office released an audit that found the public school system in Robeson County misused $3 million in Medicaid funds meant for children with special needs.

From an Associated Press article about the audit:

The audit issued Monday says for three fiscal years starting in 2011, the school system did not use about $1 million per year in Medicaid reimbursements to provide services for special-needs students as required.

The school system said in a letter to the auditor’s office that it wasn’t told by state education officials that the money was required to be used for special-needs students. It acknowledges that reimbursement money went to other district needs.

State schools Superintendent June Atkinson said in a letter that education officials will work with Robeson County and districts statewide on how the reimbursements are used.

Click here to read the entire audit.

Robeson County officials settled a complaint with the federal justice department this week, saying it would take steps to improve access for disabled residents to public resources.

The federal agency had found the county had numerous violations of the Americans with Disabilities Act (which was passed 25 years ago) , leaving those with disabilities unable to access county services and programs as easily as other citizens.

A news release from the U.S. Justice Department about the settlement noted that Robeson County, on North Carolina’s border with South Carolina, has a poverty rate of over 30 percent, and nearly 40 percent of its population identities as Native American, and 25 percent is African-American.

According to the settlement, the county agreed to make changes to buildings and county property so that parking, building entrances, restrooms, service counters and drinking fountains can be accessed by those with physical disabilities. The sheriff’s office will also have to devise a plan so that its deputies and emergency responders can communicate with those who are deaf or hard-of-hearing, and accommodations will be made at voting sites so that those that use wheelchairs or who are blind or with vision issues can cast votes without hindrances.

The settlement comes the same week the N.C. Auditor’s Office released an audit that found the public school system in Robeson County misused $3 million in Medicaid funds meant for children with special needs.

From an Associated Press article about the audit:

The audit issued Monday says for three fiscal years starting in 2011, the school system did not use about $1 million per year in Medicaid reimbursements to provide services for special-needs students as required.

The school system said in a letter to the auditor’s office that it wasn’t told by state education officials that the money was required to be used for special-needs students. It acknowledges that reimbursement money went to other district needs.

State schools Superintendent June Atkinson said in a letter that education officials will work with Robeson County and districts statewide on how the reimbursements are used.

Click here to read the entire audit.

Commentary

After reading this fact sheet from the American Public Health Association (APHA), it is apparent that NC policymakers need to take action in order to improve our state’s public health. If our state legislators were assigned a grade for how they are investing in NC’s public health, it would not be a passing grade. The following statistics show there is much room for improving NC’s public health rankings:

  • Ranks 8th for prevalence of diabetes amongst adults.
  • Ranks 47th for the availability of dentists.
  • Ranks 10th for infant mortality.
  • Ranks 47th for the amount invested in each person’s public health needs. NC spends $11.73 per year per resident.
  • Ranks 5th for the number of children living in poverty.

While these numbers are unimpressive at best, there are some public health areas that NC has improved on. First, the high school graduation rate has improved, but then again the Senate budget proposes tax cuts that lower the number of teacher assistants, which could negate the progress made. Second, NC has made great progress in reducing air pollution, but then again the House wants to cut auto emissions tests in some counties.

Even though the sequester led to significant cuts in public health funding, there is federal funding available to address the poor rankings listed above. NC could receive funding to help the following:

Fifteen percent of North Carolinians are uninsured and 500,000 people are in the Medicaid coverage gap. These are people that could seek primary preventative health care that will yield better health outcomes such as prenatal and maternity care to ensure healthy outcomes after childbirth. Research has shown that children eligible for Medicaid miss fewer school days, have higher educational attainment. and their families have more financial security. There are also 150,000 people in NC in the coverage gap with mental health and substance use disorders that need ongoing treatment. The Affordable Care Act has written into law that the federal government will cover 100% of Medicaid expansion costs until 2016 and up to 90 percent of costs starting 2020. Ensuring coverage to one half million North Carolinians is one public health act that will pull NC up the rankings.