The Senate’s budget proposal for the next two years had some significant health policy changes packed into it, namely a proposal to peel Medicaid oversight away from the N.C. Department of Health and Human Services and open the door for managed-care management of the $14 billion program.

House and Senate Republicans have spent the last few years debating what to do with Medicaid and how to address routine budget overruns from the federally-mandated program that provides health care coverage for low-income, seniors, the disabled children and some of their parents and the disabled.

House members favor keeping Medicaid within DHHS, and phasing in changes that would open up the Medicaid program to management from non-profit groups (called ACOs, or accountable care organizations).

Sen. Ralph Hise, the Republican senator from Spruce Pine who has long pushed for a managed-care solution to Medicaid, said that beginning the Medicaid reform process and moving Medicaid administration into a stand-alone division would allow the legislature to better predict and cap costs for what is the state’s largest program. (Scroll down to watch video of Hise talking about the Senate budget proposal.)

The Senate proposal does have room for ACOs, with options to have managed-care companies offer state-wide coverage while also having six regional divisions that will have slots for ACOs to work, Hise said.

Any changes to the state Medicaid program will need federal approval as well.

The Senate budget, which is expected on the floor for a vote tomorrow, would also cut ties with Community Care of North Carolina, a provider-led network that had been credited with keeping Medicaid costs down by closely managing patient cases, and pairing high-risk patients with primary care physicians. The contract with the state would end by Jan. 1. The cut will amount to a $32 million cut in the 2015-16 budget year, and savings of $65 million in the second year.

There were plenty of other note-worthy details in the budget proposal, with some re-investments in some areas of the budget, and cuts in the others. To read the 504-page budget, click here. The accompanying money report is herehere.

Among the proposed changes were proposals to:

  • Eliminate 520 slots in the state’s pre-kindergarten program, which currently offers early education offerings to 28,700 low-income children.
  • Get rid of the state’s “certificate of need” process by 2019, in which hospitals and medical centers need to make a case to state regulators for adding surgical or other specialized medical offerings, in favor of a more free-market approach that’s been a cause long championed by conservative groups in the state.
  • Extend the foster care age to 21, offering more help for children instead of cutting them off from state services at age 18.
  • Shut down the Wright School, a part-time residential facility in Durham County that provides inpatient help for children with severe disabilities and behavioral issues.
  • Get rid of the Office of Minority Health in DHHS (cut of $3.1 million). Senate Republican leaders said Monday the elimination would allow more money to flow through to actual services that affect minority populations including teen pregnancy and sickle cell programs, but Democrats argued an office dedicated to looking at overall health disparities between racial groups was important.

N.C. Health News has a great rundown as well about what’s in (and what’s not in) the budget. You can read that here.


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HisemugWell, that didn’t take long. Senate Bill 3 for the 2015 session is entitled: “AN ACT REPEALING PUBLIC EMPLOYEE PAYROLL DEDUCTION FOR PAYMENTS TO EMPLOYEES ASSOCIATIONS.”

The sponsor is Senator Ralph Hise (pictured at left). That would be the same Ralph Hise who was opposed by the State Employees Association of North Carolina (SEANC) in last year’s GOP primary.

Immediately after the election failure, the SEANC folks had this “no hard feelings” observation in one of their newsletters:

“Sometimes we win, as in the case of Erica Smith-Ingram of Senate District 3 who knocked off long-time, incumbent Sen. Clark Jenkins, and sometimes we lose as in the case of state Sen. Ralph Hise or Wake County District Attorney candidate Boz Zellinger. While we disagree on policy, we congratulate all of the winners and look forward to working to promote public services and YOU, the people who provide them, with a well-deserved pay raise and retiree COLA in the near future.”

Apparently, Senator Hise (read more about his interesting career away from Raleigh by clicking here) missed the memo.


State Senator and Mayland Community College “Coordinator of Special Projects,” Ralph Hise

Sensing building momentum for the expansion of Medicaid under the Affordable Care Act that would both cover hundreds of thousands of uninsured low income North Carolinians and bolster the state’s economy with billions in federal dollars, right wingers appear to have launched a new campaign of propaganda and distortion.

A prime example is this article on conservative website known as Watchdog Wire. In it, the author revives and recycles multiple absurd untruths about the supposedly ginormous cost to the state of Medicaid expansion — which she attributes to State Senator and Mayland Community College “Coordinator of Special Projects,” Ralph Hise. According to the article:

“the state would have to cover administrative costs to the tune of $2 billion per year. That’s a ’50-50 split’ said Hise.”

This is utter nonsense. As this detailed analysis by the North Carolina Institute of Medicine shows on page 5, the financial impact to the state from 2014 to 2021 if the it expanded Medicaid under the ACA is a net savings of $65 million. Hise’s “$2 billion” claim is simply out-of-thin-air malarkey.

The article also quotes Hise for the following supposedly damning criticisms: Read More


If you were fortunate enough in this past election to have someone other than your campaign committee pay for the production of your radio or television ads — or for their air time — you might want to check your disclosures.

In an opinion handed down today, the state Court of Appeals ruled that sponsors of political ads aired on radio or television  include both the producers of the message and the buyers of the media time, and that any such ads must disclose both in order to comply with the state’s “stand by your ad” law.

The case arose out of the 2010 battle for the 47th Senate District seat between Democrat Joe Sam Queen and Republican Ralph Hise.  Hise won that election, and as we reported earlier, Queen later sued the Hise Committee for failing to disclose in television ads that the Republican party had purchased the air time for those ads.

Both candidates received contributions from their respective parties which they used for ad buys.  In Queen’s case, the Democratic party  wired money to his campaign committee, which in turn used those funds to buy media time.  But for Hise, the Republicans sent funds directly to the media buyer, which then bought air time once Hise approved an ad.

Queen argued that because the Hise committee never had control over those funds, it could not  disclose itself as the sponsor of ads; rather, the Republican party should have been identified as the sponsor.

But the Court of Appeals didn’t reach that argument,  finding instead that both campaigns failed to comply with the law by not disclosing who paid for both the production and the air time for their respective messages.

“We hold that payment of production costs for the ‘message,’ here the videos, constitutes part of the sponsorship of an
‘advertisement’ under [the law],” wrote Judge Donna Stroud for a unanimous panel.  . . . “Thus, where different entities or individuals jointly purchase the message, the air time, portions of either, or both, they must disclose joint sponsorship under this section.”

Because the law requires aggrieved candidates to have otherwise fully complied with its provisions — which Queen did not — he could not recover any damages from Hise.




Here’s an interesting twist to the growing perception that partisanship and private money are creeping into judicial elections: What happens when elected judges are asked to interpret campaign finance rules that have governed their own campaigns?

That’s what’s playing out in a case argued yesterday before a three-judge panel of the Court of Appeals involving provisions of the state’s “stand by your ad” law. That law requires candidates or committees to disclose who’s paid for television ads they run.

After the 2010 election, the Friends of Joe Sam Queen — the committee for the Democratic candidate running for the 47th Senate District seat that year — sued his challenger Ralph Hise’s committee and the Republican Executive Committee for violations of that law.

Hise went on to win that seat, and is now seeking re-election. Joe Sam Queen is running for a House seat this year.

In the case before the court, Queen claimed that the Republicans paid for Hise ads but didn’t disclose that, allowing the ads to air instead with the statement “paid for by Ralph Hise for Senate.”

His committee wants to collect the nearly $250,000 Hise paid for those ads as damages, as permitted under the “stand by your ad” law.

But the Hise committee said he paid for the ads by virtue of an account the Republicans had set up with the campaign’s media company, American Media, for the benefit of candidates. The party deposited funds into that account, but only after Hise approved an ad could American Media draw down on that account to pay for air time and expenses. Read More