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The N.C. Department of Health and Human Services released a cheerful video this afternoon touting the supposed successes of the state’s new Medicaid billing system that delayed payments for thousands of medical providers for months over the last year.

The nearly 4-minute video produced by state employees includes interviews set to upbeat instrumental music with several providers and DHHS officials talking about how well the complicated Medicaid billing system is working one year after its bungled July 1, 2013 launch.

Much of the system is working now, and providers are getting paid faster than before, DHHS officials say in the video.

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 N.C Tracks replaced the state’s previous 25-year-old Medicaid system and came online despite warnings in a May 2013 performance audit from the state auditor’s office that DHHS hadn’t fully tested the system, left too much up to vendors’ discretion and had no way of knowing ahead of time if the system was ready.

The billing problems have left legislative fiscal research staff without firm budget numbers on the $13 billion program, a major point of contention in the current budget negotiations for Republican state Senate leaders.

Missing from DHHS’ birthday video were some of the choicer statements doctors, lawmakers and others have had about new system and its rollout last year under N.C. DHHS Secretary Aldona Wos.

Here’s a few of the less-than-glowing comments:

  • “NCTracks has made billing go from complex to borderline impossible,” said Sandra Williams, chief financial officer of Cape Fear Valley Health System, at an October legislative hearing.
  • “NCTracks was a disaster, and the State was beyond the point of no return,” lawyers wrote in a lawsuit filed by medical providers in January against the state agency.
  • “We are pretty much in the dark with trying to figure out where we are in the current year,” said Susan Jacobs, a fiscal analyst for the legislature in January about getting budget data from N.C. Tracks.
  • “It’s June 19 and we still don’t have the numbers,” Sen. Tom Apodoca, a Hendersonville Republican, said in a hearing earlier this month about Medicaid budget information, according to the News & Observer. “If push comes to shove, we can always issue subpoenas.”
  • “We are having to manually key claims and do things that before would pay automatically,” Laura Williard of High Point’s Advanced Home Care told WNCN in early June. “At one point, I had 11 temps working for our company to do something that was paid automatically before.”

As illustrated by Thomas Mills with Politics NC, the state budget will inevitably reflect the ideological interests and goals of the men in charge of our state legislature rather than the actual needs of real people. He writes of their personal motives:

The GOP is only unified about two things. First, they want to make sure that the rich and big corporations don’t have to help close the budget hole that the legislature gave us. That’s a burden for the rest of us to shoulder. Second, they want to give teachers pay raises. And that’s to protect their seats by appearing to support public education. Not many people are buying it but that’s their story and they’re sticking to it. 

Having connections with big money and corporate interests, our legislative leaders are not working to serve the people but to serve big business and the “free market.” Mills further states:

The competing budgets are a reflection of the men who run the legislature. The senate budget is an ideological document hell bent on protecting the free market principals and social Darwinism that Phil Berger has so vigorously embraced. He’s a Calvin Coolidge Republican who believes in Coolidge’s famous quote, “The business of America is business.” What Coolidge Republicans like to forget is that his policies led to the Wall Street crash of 1929 that, in turn, led to the Great Depression.

Will the new budget help us or harm us? Our leaders are not interested: their main concern is upholding the economic privilege of North Carolina’s wealthiest, even if that means compromising the needs of the majority of its citizens.

Gov. McCrory’s proposed budget for fiscal year 2015 and respective budgets by the House and Senate include significant cost savings from closing and downsizing various correctional facilities. Savings from these changes total around $14.2 million in both the House and Senate budgets and $14.9 million in the Governor’s budget.

Savings generated from these changes could have been used to promote safer communities across the state.  However, lawmakers went down a different path. For instance, Gov. McCrory advocated for state funding for drug treatment courts to be included in the state’s current fiscal year budget. These courts cost a fraction of the nearly $28,000 it cost to keep individuals in prison. However, the final budget passed last year by state policymakers did not include funding for drug treatment courts.

All three budget proposals for fiscal year 2015 – which begin July 1, 2014 – fail to include funding for drug treatment courts. The House and Senate budgets, however, go further and cut funding for programs that promote fair and equitable access to the justice system and safe communities across the state.

Funding cuts to Justice and Public Safety in the House and Senate budgets include:

  • Elimination of the Access to Civil Justice Fund, which supports the representation of poor North Carolinians in civil cases.
  • Reduction of administration funding for Indigent Defense Services, which in part oversees the provision of legal representation to indigent defendants and others entitled to counsel under North Carolina law.
  • Reduction of administration funding for Administration of the Courts

Due to tax changes enacted last year, state policymakers are constrained in major ways. This is effectively a self-imposed budget challenge. Nevertheless, as demonstrated with choices made within the Justice and Public Safety area of the budget, where there’s a will, there’s a way.

Budget writers found revenue by making significant changes to the operations of various correctional facilities as well as by cutting state funding for programs that work to enhance the efficacy of the state’s justice system. These state funding cuts would limit service providers’ ability to assist individuals and families in need to legal representation.

What is clear from all three budgets is that state lawmakers are continuing down a dangerous path of more state funding cuts rather than reinvestment as the state recovers from the Great Recession. One can only hope that as budget writers work to negotiate a final budget for the upcoming 2015 fiscal year, state funding is restored for these programs that were put on the chopping block in the House and Senate budgets.

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.

 

State lawmakers haven’t decided if the N.C. Education Lottery will be able to double the number of ads it runs and then use proceeds from increased sales to pay for teacher raises.

The House and Senate sides of the Republican-led legislature have stark differences in this year’s budget, and one of the biggest areas of difference is how to pay teachers and with what money.Lottery

House lawmakers want to double the advertising budget for the state-run lottery, in hopes it would turn out $106 million extra dollars to use for teacher raises. The budget proposal also includes several restrictions on advertising– including disclosing the odds of winning a top prize and a ban on advertising during collegiate athletic events.

(In case you missed, N.C. Policy Watch published an analysis of 2013 lottery data yesterday that found that all 10 of the counties with highest per capita sales all had high rates of poverty. Click here to read the article.)

The Senate proposed a much different teacher salary plan that required teachers to give up tenure in exchange for raises paid for with cuts to other education programs and the state Medicaid program.

Senate members heard from the N.C. Education Lottery director Alice Garland, who said the proposed restrictions put in place by state Rep. Paul “Skip” Stam, a longtime critic of the lottery, was an attempt to get rid of the lottery.

“The author of this language wants to see the lottery fail and wants to put the lottery out of business,” Garland said. “That is why those restrictions were put in the House budget.”

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