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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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UNC Board of Governors Chair John Fennebresque at the Feb. 2015 meeting. (Photo taken by Sarah Ovaska)

UNC Board of Governors Chair John Fennebresque. (Photo taken by Sarah Ovaska)

The N.C. Senate made their choices Wednesday for appointments to the University of North Carolina’s Board of Governors. The House will vote on their slate of candidates tomorrow.

Several of the 30 candidates vying for the 16 open slots on the UNC Board of Governors have also been significant contributors to political campaigns, with more than $1 million in contributions coming from the nominees and their immediate family members.

The new members will join the board at the start of the next fiscal year, on July 1.

John Fennebresque, the chair of the UNC Board of Governors who was reappointed on Wednesday, has personally written more than $250,000 in checks to state political campaigns since 2007. (Click here to read my report from earlier today about the connection between the UNC Board of Governors and political campaigns.) Read More

NC Budget and Tax Center

AF-Jobs

As long as North Carolina’s overall job creation remains anemic and rural regions continue to lag behind the rest of the state, it will be critical to adequately invest in proven economic development strategies like increasing small business lending, supporting development in economically-distressed communities, and strengthening the nexus between cutting edge research and innovative industrial development in key sectors. These are many of the types of investments that made North Carolina a leader in innovative economic development over the past 30 years.

Although significantly less supportive of these efforts than in past years, the House budget proposal for FY 2014-2015 does a better job of funding the state’s most effective economic development investments than does the Senate proposal, which relies on largely unproven strategies like fracking.

Both proposals are ultimately constrained by the continued commitment to tax cuts that primarily benefit the wealthy and profitable corporations that are also unlikely to deliver on the job creation promises that their proponents have made.

In the years since 2011, the General Assembly has largely dismantled much of the state’s most innovative economic development efforts. It eliminated the nationally-acclaimed rural development entity—the N.C. Rural Economic Development Center, dramatically scaled back investments in the biotech sector, abolished the state’s regional economic development planning partnerships, and eliminated state support for 13 nonprofits performing community-based economic development in the state’s most distressed communities. Both budgets continue this long-term trend of dismantling North Carolina’s system—the House just restores some of the lost investments.

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Uncategorized

ff3072013We’re just a couple of weeks into the 2014 session of the North Carolina General Assembly, but the annual legislative silly season has already commenced. Not familiar with silly season? That’s the time of year in which legislative leaders force their members to work all kinds of silly, late night hours in order to limit media coverage and handicap/wear down those who might want to criticize or contest their agenda (i.e. the minority party).

Usually, silly season doesn’t start until there have been several months (or, at least, several weeks) of actual, semi-normal  legislative process, but this year, in keeping with the current majority’s increasingly pathological aversion to sunlight and transparency, it’s starting just days after the session itself commenced. The Senate is kicking silly season off today with a wholly unnecessary Friday afternoon session, followed by an even more unnecessary post-midnight session early tomorrow morning, during which it will ram though its destructive 2015 budget proposal.

And lest you get the mistaken impression that lawmakers will actually be working longer hours during silly season, rest assured that this will almost certainly not be the case. Read More

Uncategorized

This morning’s editorial in the Charlotte Observer gets yesterday’s state Senate proposal on teacher pay and the “choice” it would offer teachers on the matter just about right:

“The plan, announced by Senate leader Phil Berger, would boost teacher pay by an average of 11 percent – the largest increase in N.C. history, Berger says. It’s significantly more than Gov. Pat McCrory proposed this month in his teacher pay plan, and it would lift North Carolina all the way from 46th to 27th in the nation in teacher pay.

That wasn’t so hard, was it?…

Then there’s the plan’s caveat: If teachers want to receive the substantial pay increase Republicans are offering, they must give up the ‘career status’ – or tenure – that N.C. law guarantees. Republicans already tried to eliminate tenure last year, but a Superior Court judge ruled this month that it is unconstitutional to take that career status away from teachers who already have earned it.

Now Republicans are trying to make teachers give tenure up “voluntarily” by dangling the pay increase in front of them. We’re not sure how the two – tenure and pay – are otherwise connected. Tenure offers teachers two primary protections – a hearing process when a teacher is being dismissed or demoted for any of 15 reasons that include poor performance and neglect of duty, plus a similar hearing process when a teacher is dismissed because of budget or staffing issues.

Both protections make it more time consuming and costly to fire teachers, but neither is costly enough to be paired with teacher pay, as Senate Republicans are doing. If they want to argue that teachers don’t deserve protection from layoffs that most of the rest of us don’t get, as Berger suggested Wednesday, that’s a legitimate and separate debate to have. But to finally give teachers the raise they’ve earned, only to make them give up the tenure they’ve also earned, is unfair.

Lawmakers should take up tenure later and concentrate on the intended task at hand – raising the pay of our public school teachers. As Senate Republicans and the governor are showing, it’s something that’s within reach, if they want it to be.”

You can read the entire editorial by clicking here.

Read more here: http://www.charlotteobserver.com/2014/05/28/4938240/forward-back-on-teacher-pay.html#.U4cMTXZB_4t#storylink=cpy
Read more here: http://www.charlotteobserver.com/2014/05/28/4938240/forward-back-on-teacher-pay.html#.U4cMTXZB_4t#storylink=cpy
Read more here: http://www.charlotteobserver.com/2014/05/28/4938240/forward-back-on-teacher-pay.html#.U4cMTXZB_4t#storylink=cpy