Raleigh, N.C. — The proposed House budget would give Health and Human Services Secretary Aldona Wos sweeping authority to run North Carolina's Medicaid program, allowing her to push forward with changes to the program's details and overall structure with relatively little intervention from the General Assembly.
"This is audacious," Rep. Verla Insko, D-Orange, said of the provision during the House Appropriations Committee's vetting of the budget Tuesday morning.
Medicaid is a health insurance program for the poor and disabled jointly funded by the state and federal governments. The language in the budget bill would allow Wos and her staff to submit changes – known as State Plan Amendments, or SPAs – to the federal government and make other changes. It creates a new legislative oversight committee that would oversee Medicaid but leave the details to the Department of Health and Human Services' chief and the appointed Medicaid director.
The main constraint on Wos' authority would be money. She could not spend more than the $3.7 billion set aside by the state and roughly $12 billion kicked in the by the federal government.
Members of the General Assembly have been discussing ways to control costs and restructure the Medicaid program for years. House and Senate leaders have had distinct ideas on how to go about what is colloquially called Medicaid reform but, thus far, have been unable to reach a conclusion.
"Is this provision a substitute for all of those proposals we have been debating?" Insko asked.
Backers of the measure said lawmakers would get advance notice of any changes and would have the power to reverse anything with which they disagree. Rep. Marilyn Avila, R-Wake, argued that lawmakers shouldn't be micromanaging details of the program when "there are extremely experienced and knowledgeable people" in DHHS.
However, it is the recent performance of the department that gives critics of the plan pause.
"There's just not a lot of confidence...to hand that much over to them," Sen. Ralph Hise, R-Mitchell, said, pointing to instances where administrators didn't follow state guidelines.
Senators have, in the past, floated a plan to create an independent panel that would run the Medicaid program. Hise said he agreed with the idea of taking smaller decisions about the Medicaid program out of the hands of the General Assembly.
House Democratic leader Rep. Larry Hall was more blunt.
"Due to the failure of DHHS to successfully manage resources and personnel, the House should take a leadership role and enact precepts to ensure that the mismanagement of the past does not continue with even more resources in the future," said Hall, D-Durham. "We should be demanding accountability from DHHS. Yet, this budget gives DHHS complete authority over a $3.7 billion portion of the budget. This budget provision hands a political appointee a blank check."