Commentary

Policy Prescription #6 – The case for Medicaid expansion remains as strong as ever

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As the 2018 legislative session gets underway in earnest in this, its first full week, we hope you will continue reading our special series “Policy Prescriptions” researched and written by A. J. Fletcher Foundation Fellow Samone Oates-Bullock. Last week, Prescription #1 addressed food insecurity in North Carolina. Prescription #2 took on the issue of early childhood investments. Prescription #3 analyzed the challenge of funding school adequately and fairly. Policy Prescription #4 called for racial equity in education. Policy Prescription #5 called for tackling the issue of environmental racism in North Carolina.

This is from Policy Prescription #6 “Closing the coverage gap: The case for Medicaid expansion remains as strong as ever”:

The Affordable Care Act (ACA) was enacted in 2010 in order to expand coverage, control rising healthcare costs, and improve the overall quality of healthcare in America. One of the major provisions of ACA was the expansion of Medicaid eligibility to low-income individuals with incomes at or below 138 percent of the federal poverty level ($28,676 for a family of three). This expansion would help to fill notable gaps in Medicaid eligibility and extend insurance coverage to low-income individuals. In 2013, North Carolina enacted legislation that prevents any state actor—including the Governor—from expanding Medicaid unless authorized by the General Assembly. As a result,  hundreds of thousands of low-income  North Carolinians are being left in the “coverage gap” — a place in which they earn  too much to be eligible for Medicaid, but too little to qualify for marketplace subsidies that would  allow them to purchase insurance in the private market. Closing the coverage gap would significantly change the landscape of healthcare coverage and access in North Carolina by providing coverage to more than 208,000  North Carolinians and, literally, saving thousands of lives.

Click here to read the entire report.

Education, News

Report points to financial, legal complications of Matthews charter school battle

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Sen. Jeff Jackson, D-Mecklenburg

A new report authored by a longtime N.C. General Assembly attorney points to multiple financial and legal complications associated with a controversial proposal to clear a town-run charter school in the Charlotte suburb of Matthews.

Among those complications, the report—written by Gerry Cohen, a former General Assembly lawyer and chief of bill drafting—notes state law bars towns like Matthews from taking on debt to build a municipal charter.

Nor would the town be cleared to use state funds in order to buy land or build a school, meaning the Charlotte suburb would likely have to cough up millions for the school upfront, possibly by raising taxes.

The report claimed significant implications for local teachers’ retirement benefits too.

Sen. Jeff Jackson, a Charlotte Democrat who opposes the Matthews charter, questioned Monday how a town with a budget of about $23 million would pay for a $30 million school. “I don’t think proponents of this bill have leveled with the people of Matthews about the fiscal realities,” Jackson said.

Last year’s House Bill 514 applies to the Charlotte suburbs of Matthews and Mint Hill, although it has the potential to set the table for similar suburban clashes in large school systems such as Wake County. And, as Policy Watch has reported, it comes laden with concerns about the creation of a predominantly white town splitting off from a decidedly more diverse school system like Charlotte-Mecklenburg Schools (CMS). 

Jackson said last year’s bill, co-sponsored by Matthews Republican Bill Brawley, would be a “precedent-setting piece of legislation” if approved by state lawmakers this year.

Rep. Bill Brawley, R-Mecklenburg

Cohen’s report was touted Monday in a press conference by critics of the so-called “secession” proposal, chief among them school district leaders in CMS. The former legislative attorney said he was asked to draft the report by CMS lawyer George Battle, although he said he was not directed what to write.

CMS officials have been engaged in a war of words with Matthews town leaders in recent months. Matthews leaders say they want more say in their local schools, as well as a long-term guarantee that the district won’t force student reassignments in order to diversify racially-isolated schools like those found in the city’s predominantly white suburbs.

The progressive N.C. Justice Center issued a report this year that found CMS to be, by far, the most racially segregated district in North Carolina (Disclosure: The Justice Center is Policy Watch’s parent nonprofit).

School district leaders counter that splitting the district would be costly and inefficient, unpopular with Matthews residents, and may only exacerbate segregation worries.

It’s unclear whether Brawley’s draft bill will be a priority for the Republican-led legislature as members ramp up their short session in the coming weeks. The bill swept through the state House last year. But after a study committee led by Brawley this year punted on any specific school system splits, the proposal seemed to lose momentum.

CMS Chair Mary McCray

CMS Board of Education Chair Mary McCray told reporters Monday that the district is speaking out forcefully on House Bill 514 after leaders “made multiple attempts to provide reasonable solutions.”

School board Vice Chair Rhonda Cheek said Cohen’s analysis “could and should cause pause” with lawmakers.

“This bill is a nightmare for taxpayers,” said McCray, arguing that residents of Matthews would be “double-taxed” to support the charter school by both the county district and the town.

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News

ACLU of NC kicks off campaign to end cash bail

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This week the ACLU of North Carolina kicked off its campaign to end cash bail .

Regular Policy Watch readers have seen our coverage of the inequities of the cash bail system and the for-profit bail bond industry.  You should also take the time to read the ACLU and Color of Change report “Selling Off Our Freedom: How insurance corporations have taken over our bail system.”

It’s an excellent companion read to this week’s edition of our Monday Numbers feature, which focuses on the causes and effects of mass incarceration.

Among the many illuminating stories, charts and figures in the report is this graphic on political contributions by the bail industry by state:

The report also looks at the problem at a federal level:

Though most political activity by bail insurers, corporations, and their associations has occurred at the state and local levels, for profit bail hasn’t ignored federal legislators.

Over five years, from 2011 through 2016, the industry funded $500,000 in contributions to federal candidates or committees. In return, Representative Ted Poe (R-TX) and Senator Orrin Hatch (R-UT) have introduced a federal version of the ABC/ ALEC anti-pretrial services legislation. And congressional opposition has surfaced to fight efforts to eliminate money bail—most notably, the No Money Bail Act, introduced by Representative Ted Lieu (D-CA), which would make states with money bail systems ineligible for certain federal law enforcement funding.

With a new federal administration and attorney general unlikely to challenge the constitutionality of certain money bail practices, the industry may shift its attention to influencing federal legislators and regulators to protect its profits.

Read the full report here.

Education, News

Facing a shortage in school nurses, N.C. lawmakers seek new standards

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Following a report that details painful school nurse shortages in North Carolina, a state legislative panel will ask for new standards and programs to address the problem.

Members of the General Assembly’s Joint Legislative Program Evaluation Oversight Committee approved that report and advanced a bill draft Monday that would do several things, but chiefly orders the State Board of Education to ready a new goal for school nurse staffing levels and a plan for meeting those levels by January 2020.

This year’s report from the nonpartisan Program Evaluation Division estimated that it would cost the state between $45 million and $79 million to meet a 1:750 nurse-to-student ratio recommended by the state board in 2004 or the one nurse per school ratio prescribed  by the National Association of School Nurses.

Public school advocates say insufficient nursing levels in schools will spell major problems, particularly for students who lack access to healthcare outside of school.

While the bill draft that advanced out of committee Monday lacks any recommended funding levels, it would direct the state to prepare a plan for combining two school nurse programs—Child and Family Support Teams (CFST) and the School Nurse Funding Initiative (SNFI)—run by the Department of Health and Human Services and the Department of Public Instruction.

Lawmakers are also moving to address Medicaid reimbursement for school nursing services. This month’s PED report pointed out that about 60 percent of medical procedures performed in schools are done by employees who are not nurses. That’s why few local school systems file for Medicaid reimbursement because, under the state’s Medicaid plan, such care must be provided by a registered nurse as directed by a physician or the students’s Individual Education Plan (IEP).

The bill draft would require DHHS to examine rates paid for school-based nursing and craft a plan for establishing Medicaid reimbursement for school nursing services. DHHS would have to report to the legislature by December 2018 on these provisions.

Watch here as Liz Newlin of the School Nurses’ Association of N.C. explains the problem facing North Carolina school systems to Policy Watch’s Rob Schofield.

Commentary

Op-ed: If we’re not going to regulate guns, at least do this

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In case you missed it, columnist Ned Barnett has a fine op-ed in this morning’s edition of Raleigh’s News & Observer in response to the latest mass school shooting. After explaining the absurdity and futility of the idea that we can arm our way to safety, Barnett acknowledges that the current General Assembly won’t do anything about limiting access to guns. But, he says, at least we can do something — namely, hiring enough counselors and psychologists to make areal difference. Here’s the conclusion:

“We need to improve the awareness of and response to students who may be prone to striking out against their teachers and other students. The teachers who rallied last week asked for more money for school counselors, nurses, social workers and psychologists. The ranks of those workers have been reduced by cuts in state funding.

Mark Jewel, president of the N.C. Association of Educators, said the legislature can help teachers “not by arming us with guns but by arming us with the support personnel who can help us with the emotional needs of our children.”

In terms of school nurses, there is one for every 1,086 students in North Carolina. The state’s recommended level is one for every 750 students. State legislative staff estimates it would cost an additional $45 million to attain that ratio. Fifty eight percent of schools do not have a full-time health professional on campus. It would cost an additional $79 million to ensure every school has a nurse.

The recommended ratio of school psychologists to students is 1 to 700. In North Carolina, the ratio is 1 to 2,100. Some rural counties do not have a single school psychologist.

School counselors, previously called guidance counselors, are also in short supply: 1 to 386 students when the recommended ratio is 1 to 250.

Gov. Roy Cooper has proposed spending for school safety that includes $40 million to go toward hiring more counselors, psychologists, social workers and nurses, and $15 million for new programs to address students’ mental health challenges. In April, a state legislative subcommittee adopted a report recommending that the state increase the number of school support personnel but did not include funding levels.

Schools need more people attuned to the physical, emotional and mental health of students. They can rescue a child from distress and perhaps spare a school from heartbreak. If state legislators are worried enough about gun violence that they need metal detectors at the Legislative Building, they ought to also provide schools with more mental stress detectors.”

Click here to read the entire essay.

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