The big change coming to NC healthcare that most people don’t know about

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The state is on the cusp of a huge change in healthcare, and most North Carolinians don’t know it’s happening, a new poll shows.

On July 1, North Carolina Medicaid will move from paying providers for each medical procedure to a managed care system, where insurance companies will be paid a set rate per person. About 1.6 million Medicaid beneficiaries  must be enrolled in one of the new health plans, according to the state Department of Health and Human Services.

Republicans in the state legislature initiated the change more than five years ago as a way to save money. Democratic Gov. Roy Cooper’s administration embraced it as a way to improve health for people who use the government insurance program that covers low-income children, some of their parents, disabled people, and elderly people.

A poll conducted for North Carolina for a Better Medicaid, a group promoting Medicaid managed care, found that 43% of Medicaid beneficiaries knew little or nothing about it. More than 60% of North Carolina residents overall knew little or nothing about the upcoming changes. Majorities had positive opinions after hearing of anticipated benefits, according to the survey sponsors.

The state Department of Health and Human Services tried to get the word out. According to an email from the agency, its paid media campaign included radio, TV ads, display, and social media ads. It used Twitter, Facebook and Instagram to talk about open enrollment deadlines, health plan options, the NC Medicaid Managed Care enrollment app, and other topics.

Additionally, Medicaid beneficiaries received enrollment packages and reminder postcards.

Open enrollment, the period when Medicaid users were to choose a health plan, ran from March 15 to May 21. As of May 22, 212,687 Medicaid enrollees had selected a health plan, while more than 1.2 million were auto-enrolled, meaning they were assigned a health plan.  Beneficiaries have until Sept. 30 to change their health plan.

The online survey of 1,000 North Carolina residents was conducted between April 29 and May 4. The data were weighted by age, gender, race, and educational status. The poll has a margin of error of 3.1 percentage points.

Members of North Carolina for a Better Medicaid include Healthy Blue – the Blue Cross Blue Shield NC Medicaid plan – United Health Group, the YMCA, NC Child, the North Carolina Black Alliance, and other groups. United Healthcare is also offering a Medicaid health plan.

(This article was updated Wednesday, June 9, to correct the reference to United Health Group.)

Who derailed Dionne Delli-Gatti’s confirmation as DEQ Secretary? No one wants to own it.

Dionne Delli-Gatti at her legislative committee confirmation hearing on April 27. (Screenshot from livestream)

Dionne Delli-Gatti waited outside the gallery entrance of the Senate Chamber Thursday afternoon to learn whether she would still have a job by the end of the day. 

She carried a keychain that her 8-year-old son had given her earlier this year after Gov. Roy Cooper nominated her to lead the NC Department of Environmental Quality, one of the state’s most complex agencies. 

The keychain read “No. 1 Secretary.”

But her position as the first woman to lead the department was in doubt. On Wednesday, the Senate Agriculture, Energy and Environment committee had voted down her nomination, a move without modern precedent. Since 2016, when Republican legislators passed a law requiring the Senate to confirm the governor’s nominees, the chamber has done so for 16 consecutive cabinet-level positions — until now.

At both that committee hearing and during Thursday’s Senate floor debate, Republican Sens. Paul Newton and Chuck Edwards led the charge against her nomination. They claimed Delli-Gatti was “disqualified” because she “couldn’t articulate the governor’s energy policy” and wasn’t familiar with the details of the MVP Southgate natural gas pipeline project. 

To Democratic lawmakers, that felt like a stretch.

“I urge you to reject this disingenuous process and stand up for what is right,” said Sen. DeAndrea Salvador, a Mecklenburg County Democrat during the full Senate debate. “Ousting a qualified woman from a position she already holds — something else is going on. It doesn’t add up.”

Why Delli-Gatti attracted the ire of the Republican leadership is unknown. Her initial confirmation hearing happened on April 27, and there were no followup meetings. Senate Democrats have said publicly they were blindsided by the news that Delli-Gatti’s confirmation was in doubt.

Two weeks ago, the Senate Energy Committee, with Newton again running the show, received testimony from Duke Energy, Dominion Energy and the American Petroleum Institute about what they view as North Carolina’s need for more natural gas pipelines. Transco is the main provider but if a cyberattack or other disaster should shut down that line, it could create an energy emergency in North Carolina, they testified.

Oddly, Delli-Gatti “wasn’t invited to participate” in that hearing, as Sen. Michael Garrett, a Guilford County Democrat pointed out during the Senate debate.

“When you vote today you are voting to fire a female veteran and the first woman to lead this department and by all standards is eminently qualified,” Garrett said.

And the reason Delli-Gatti didn’t “articulate the governor’s energy position,” said Sen. Julie Mayfield, a Buncombe County Democrat, is because Cooper has not articulated it himself.

“If the governor has not expressed a position on natural gas, is it fair to expect her to know what that position is, given that it doesn’t exist?” Mayfield said.

Chief Deputy Secretary John Nicholson is the new interim secretary for the NC Department of Environmental Quality.

Over the last day, Democrats have engaged in amateur sleuthing to flush out who had tanked the governor’s choice. Shortly after Wednesday’s committee vote recommending against her confirmation, Duke Energy released a statement supporting Delli-Gatti. By evening, Dominion Energy had done the same. 

Legislative sources told Policy Watch that the NC Chamber of Commerce, Smithfield Foods and the NC Pork Council were not responsible for the confirmation derailment.

That left few options: Either another powerful natural gas company put its invisible finger on the scale or Sen. Newton and several of his colleagues had gone rogue, as one source told Policy Watch, “to send a message.”

Theresa Kostrzewa, a lobbyist for EquiTrans Midstream, a major partner in the MVP Southgate project, told Policy Watch that the company did not oppose the nomination. “They were shocked,” Kostrzewa said of her clients. (She also represents Smithfield Foods; the company did not oppose the nomination, either, she said.) Read more

State legislature faces acid tests on transparency in budgeting, map-drawing

RALEIGH – For most people, 16 West Jones Street has a far less familiar ring than 1600 Pennsylvania Avenue. But what happens inside the Legislative Building on Jones Street in Raleigh is just as critical to the lives of North Carolinians as what goes on in the White House or on Capitol Hill.

Within the columned walls of the legislature, 170 lawmakers make decisions that directly impact our state’s 10 million residents. From our schools and roads, to healthcare, water quality and access to the ballot box, these legislators play a central role in determining the direction of our state.

It’s vital that the people of North Carolina have a front-row seat to keep tabs on their representatives and weigh in on the lawmaking process. Of course, most folks don’t have time to travel to Raleigh to sit in committee meetings or floor debates. And the COVID-19 pandemic has made venturing to the legislature especially challenging this past year.

Thankfully, we’re fortunate to have some outstanding journalists providing solid coverage of the legislature. Due to the ever-changing landscape of the news industry, there’s a smaller number of reporters assigned to the General Assembly beat than in times past. But the brave few who do remain put in long hours, sometimes well into the night, helping to make sense of the crush of bills and shining a light on what our lawmakers are up to.

As a nonpartisan, grassroots organization, we at Common Cause NC also strive to keep the public informed about what’s happening on Jones Street, with an eye towards holding lawmakers accountable to their constituents. A half-century ago, we were founded as “the people’s lobby.” We take that mission seriously, working to ensure everyday folks are not forgotten within the halls of the legislature.

Meanwhile, legislative leaders deserve some credit for making the General Assembly’s activities a bit more accessible for the public, with live streaming video of committee meetings and House sessions now available through the legislature’s website at There’s still much more to do on the transparency front, however, such as posting video recordings of legislative proceedings online for those who can’t tune in live. And the state Senate should follow the House’s lead in turning on cameras in its chamber.

At you can also find information on bills and how to contact your legislators. It’s important to let lawmakers know what you think about the issues that matter most to you.

Just how truly committed legislative leaders are to openness will be tested in a big way as lawmakers work on a multi-billion-dollar state budget and when this year’s session enters its homestretch. That’s when any pretense of transparency is sometimes recklessly thrown overboard as surprise bills proposing sweeping policy changes occasionally pop up without warning, pushed through by the majority party with little or no public input.

The transparency test will also be key later this year as lawmakers begin the process of drawing new congressional and legislative voting districts. Will legislative leaders shortchange the people of North Carolina through a rushed and partisan redistricting process? Will they craft gerrymandered districts behind closed doors, with politicians trying to shield themselves from accountability to the public?

Or will lawmakers break from the sordid past of gerrymandering? Will they hold meaningful public hearings, actually listen to community members and draw districts that let voters choose their representatives? That would be refreshing and what’s needed to avoid more illegal map-rigging by politicians.

We’ll get an answer to these questions in the coming months. If history is a guide, we the people will need to be vigilant, speak out and demand full transparency from legislators drawing our voting districts.

For now, keep an eye on Jones Street.

Bob Phillips is executive director of Common Cause NC, a nonpartisan, grassroots organization dedicated to upholding the core values of American democracy.

House Bill 500 would fund levees, buyouts in some flood-prone areas of NC

Seven Springs in Wayne County is on the banks of the Neuse River. The slashed blue lines represent a floodway, which encompasses the Whitehall Cemetery. The solid blue color indicates areas that are in the 100-year flood plain, meaning in any given year the chances of a major flood event are 1%. Yellow areas represent the 500-year flood plain, equivalent to a 0.2% chance. However, as climate change contributes to stronger storms, these metrics are becoming outdated. (Map:

Main Street in Seven Springs, a tiny town in Wayne County, sits squarely within harm’s way. Sandwiched between a bluff and the Neuse River, the entire town lies within the highest-risk flood zones, according to state and federal maps, and risks being swept away altogether during the next major hurricane.

The town would get a new $5.2 million levee, under legislation discussed in the House Environment Committee Tuesday afternoon. House Bill 500, the Disaster Relief and Mitigation Act of 2021 would allocate $200 million for various projects to make communities more resilient against hurricane and severe storm damage.

“At one time Seven Springs had 200 residents,” said Republican Rep. John Bell, a bill co-sponsor, whose district includes Wayne County. “Now it has about 20. We need to help revive that town.”

Seven Springs has already moved offices for its first responders and emergency medical services to higher ground, Bell said.

Other areas in eastern and southeastern North Carolina would also receive funding improvements; the money would flow through the state Office of Resilience and Recovery.

Neuse River flood mitigation

$5.2 million for a Seven Springs levee
$5 million for Stoney Creek acquisition, also in Wayne County
$12 million for 301/railroad elevation
$10 million for buyouts

Lumber River flood mitigation

$18 million for channel widening
$5 million for Lumberton/CSX floodgates
$3.5 million for a Fairbluff levee
$10 million for buyouts

Rep. Edward Goodwin, a Republican who represents six northeastern counties — also flood-prone — asked Bell to consider spreading the largesse to other parts of the state.

“Is there any hope for us?” Goodwin said, referring to his district: Bertie, Camden, Chowan, Perquimans, Tyrrell, and Washington.

“Yes, I’d be happy to talk with you,” Bell replied.

The bill lacked some details, such as which channel would be widened and what properties would be eligible for buyouts. The money would allow local and state government to apply for federal grants.

The legislation will likely undergo several iterations before going to the full House. Its next step is House Appropriations.

You can plug in an address or city into and learn if that location is in a flood-prone zone.


The NC proposal for signing bonuses comes with provisions making the unemployment system “even more miserly,” an analyst says

Sen. Chuck Edwards

A plan to lure unemployed people back to work with signing bonuses  passed the state Senate on Tuesday in a 35-10 vote.

Under the bill, unemployed people who accept jobs within 30 days after the bill becomes law would get $1,500 signing bonuses. Unemployed people starting new jobs between 30 and 60 days would get $800.

The bonuses would help employers find workers and help employees change the habits they developed during pandemic unemployment, said Sen. Chuck Edwards, a Henderson County Republican.

“Humans are a creature of habit, and we’ve created a habit now for 14 months that many folks can simply just get by, and it’s easier to not work than it is to work,” Edwards said at a news conference Tuesday afternoon.  “I know that a lot of folks are going to look at this bill and see it as something that is sought to just help employers. And while it is important to help our employers and get our economy back on track for all of our sake, I believe there’s a lot in here for someone who is unemployed and that is to change a habit.”

The state’s seasonally adjusted unemployment rate has been declining since May 2020, when it was 13.5%, according to the state Department of Commerce. The state’s April unemployment rate stood at 5%. In February 2020, before pandemic-related business shutdowns, the state’s unemployment rate was 3.6%.

Though the bill passed with bipartisan support, it faces more hurdles. The bonuses would be paid with money from the federal pandemic unemployment fund, which does not allow the money to be used for  bonuses. The bill would require the state to seek permission from the US Department of Labor to use the money for bonuses.

The Senate blocked one proposed amendment that would have raised the state minimum wage to $15 an hour, and another that would have increased state weekly benefits to a maximum of $500 from $350 when federal benefits end in September, and allow unemployed people to receive benefits for up to 26 weeks.  Under current law, state benefits last from 12 weeks to 20 weeks, depending on the unemployment rate.

“A false narrative is being pushed, that North Carolinians are lazy and don’t want to work,” said Sen. Wiley Nickel, the Cary Democrat who sponsored the amendment to increase benefits.

The state slashed unemployment benefits in 2013 to pay back money the state owed the federal government.

North Carolina now has $2.7 billion in its unemployment trust fund, Nickel said, plenty of money to help both workers and employers.

Nickel proposed giving employers a 12-month break from unemployment tax payments.

After tabling the two amendments, the Senate approve the bill with bipartisan support and sent it to the House.

The bill goes beyond bonuses to make permanent changes to the unemployment system that will make it harder for people to qualify for benefits, said John Quinterno of South by North Strategies, an economic and social policy research firm in Chapel Hill.

“You’re creating permanent changes to our state system, making it more punitive and even more miserly than it currently is,” he said.

Under the bill, unemployed people would have to respond to an interview request within 48 hours and schedule an interview within seven days if the employer asks. Job seekers must maintain records of interview requests and responses.

A reemployment activity sponsored by a job center would no longer count as one of the three weekly contacts a job seeker must make in order to qualify for benefits.

A state would have to conduct an audit, using an outside firm if necessary.

The new provisions could disqualify more people from receiving unemployment benefits and would force people into low-wage work, Quinterno said.

“In a way, this is the government intervening to stop market forces from working,” he said. “It’s just that we love markets except when it’s a labor market that might generate higher wages for people. It’s part and parcel in the war on unemployment insurance we’ve been waging in North Carolina for closing in on 10 years now.”