@NCCapitol

NC Medicaid cuts lead to blame game

Posted October 27, 2011
Updated December 6, 2011

— North Carolina's Medicaid program is facing a $139 million shortfall because it can't reach the savings required in the state budget and other agency liabilities that weren't paid for in the spending plan, according to state health regulators.

Republican lawmakers passed a $19.7 billion budget – over Gov. Beverly Perdue's veto – that called for cutting $356 million from the Department of Health and Human Services. Agency officials told a legislative oversight committee Thursday that they can't make all of the required cuts.

Lawmakers overestimated some cuts that have to be approved by the federal government, officials said. That process takes months, but budget writers calculated the savings as if they had started immediately.

Other requested cuts would break Medicaid program rules, which could cost the state millions in federal revenue.

The shortfall means state leaders will have to find a way to close the gap between revenue and expenditures for Medicaid, the government-run health care plan for poor children, older adults and the disabled.

Medicaid is an entitlement program, so the state must pay for services paid through the program for nearly 1.5 million recipients. The budget for the division overseeing Medicaid is almost $3 billion.

The General Assembly already has given Health and Human Services Secretary Lanier Cansler authority to reduce or eliminate optional Medicaid services if the cost savings mandated in the budget aren't being reached. Optional services include podiatry and dental care, as well as hearing aids and organ transplants.

House Speaker Thom Tillis said Thursday that lawmakers weren't aware of the problem at DHHS.

"A lot of those cuts were made in consultation with the secretary and the Department of Health and Human Services," Tillis said. "Obviously, if we'd been consulted by them and they said they weren't possible to begin with, (the cuts) wouldn't have been in there."

Legislative panel hears of money woes in NC Medicaid program Legislative panel hears of money woes in NC Medicaid program

Cansler quickly sent oversight committee members a letter noting that budget writers were fully aware of the difficulty in making cuts to some of the agency's programs.

"The true nature of these cuts was pointed out to you in letters from Gov. Perdue dated May 27 and June 2, 2011," Cansler wrote.

Medicaid probably will fail to achieve $27 million of savings this year because less than half of the proposed changes to the state program have yet to be approved by the U.S. Centers for Medicare & Medicaid Services, DHHS officials said. GOP lawmakers have said previously state regulators should press the Obama administration to approve more quickly state changes to the Medicaid plan to accelerate savings.

Community Care of North Carolina, a highly successful managed care program for Medicaid patients, was directed to find $90 million but now anticipates a minimum of $51 million due to timing issues related to enrolling more older adults and people with disabilities, officials said.

A report from Deputy DHHS Secretary Michael Watson also said the legislature didn't set aside $41 million to help pay for a previously disclosed $300 million accounting error in 2008 that resulted in overpayments. The state also must repay $42 million after a federal audit found personal care services were either billed improperly or had inadequate documentation from providers, the department said.

The state could have other options for erasing the shortfall – tax collections are running $150 million above forecasts through the first three months of the fiscal year, and there's almost $300 million in the state's rainy-day reserve fund. But the surplus could quickly dry up if unemployment remains above 10 percent, and reserves may be needed to pay for agricultural damages related to Hurricane Irene.

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  • carolinapatriot Oct 28, 2011

    -razor2- Wrong, a real patriot fights for the liberties of all men, not one group or the other. The government is not the sole instrument for caring for those in need. But the government has done a lot to create the scenario you have described that put people in need.

  • razor2 Oct 28, 2011

    please bump this story back up to front page

  • razor2 Oct 28, 2011

    Doctors preform Gastric bypass surgery for the reason of getting
    uncontrollable weight problems that are creating serious diabetic
    problems for the affected person. Doctors are held accountable by
    their oath to heal and protect as well as guidelines put in place
    by a board of other doctors who oversee that the laws of this country are taken into consideration before a surgery is preformed.. Get your facts straight and leave our overworked healthcare professionals out of it..

  • affirmativediversity Oct 28, 2011

    Anyone remember when Medicaid for Pregnant Women meant medical coverage for a pregnancy only...ie. a woman's obgyn, labor and delivery? Well that's not how it is now...now Medicaid for Pregnant Women includes EVERYTHING...dental, eye glasses, prescriptions, none pregnancy related procedures...EVERYTHING!!!! AND you baby receives ONE YEAR FULL MEDICAID AUTOMATICALLY...no matter your income or resources...

    Want to know where your medicaid money is spent...stop falling for the "blame the disabled" ploy and start taking a hard look at all the adults who receive medicaid soley because they have or are having children!

  • affirmativediversity Oct 28, 2011

    The biggest expenditure for Medicaid is not Medicaid for the Disabled. That, frankly, is one of the hardest programs to qualify for!!!!!!!

    The BIG medicaid expense is FAMILY AND CHILDREN MEDICAID...specifically the adults who qualify for medicaid soley because they have children...they can visit any ER at any time for any reason with ZERO copay, have all their prescriptions paid with a very minimal copay, can go see any doctor or stay in the hospital as long as the doctor will keep them, have elective surgery (ie. gastric bypass...YES, medicaid pays for gastric bypass surgery), full dental with no share or copay...AND BELIEVE ME THEY TAKE FULL ADVANTAGE...it doesn't matter if they are working or even if they win the lottery...all they have to do is qualify ONE MONTH and they will AUTOMATICALLY be ENTITLED TO TWO YEARS FULL AND FREE HEALTH/DENTAL/PRESCRIPTION DRUG COVERAGE...just for having children!!!!!!!

  • razor2 Oct 28, 2011

    Why are so many people on these programs to start with hmmm...
    The groups most affected that receive these benefits have no other alternative in most case and have to depend on these resources to live. The reason most people cant pay is because the insurance companies (paid protection racket)have inflated costs so much due to the lawsuits filed by Lawyers who worked the system to steal millions of dollars for self gain to the giant
    pharmaceutical corporations that make the medicines that costs have gotten out of reach for most people to afford. There are just so many trickle down elements involved in this but it all leads to one thing GREED on the part of a select few that has ravaged our lives,and families. Its not a matter of any of the false stories of someone trying to take another's wealth like some people are trying to spin here get your heads out of the sand and figure it out for yourself. A real patriot fights for the weak not the strong.

  • barbstillkickin Oct 28, 2011

    WELL LambeauSouth I AM SORRY ABOUT YOUR SISTER. YES I CAN ENTERTAIN MYSELF JUST FINE AT HOME. IF YOU COULD IMAGINE BEING IN A PLACE WHERE NO MATTER HOW MUCH YOU TRY YOU JUST CAN NOT LEAVE WITH OUT HELP. I KNOW THERE ARE SEVERAL FORMS OF HANDICAP AND I BELIEVE A LOT IS UNNOTICEABLE BUT I AM SAYING THAT MEDICARE DOES NOT HELP THE POOR LIKE ME TO GET A WAY TO GET OUT OF THE HOUSE. NO ONE HAS JOBS NOW I KNOW THAT AND I AM VERY SYMPATHETIC. IF LIFE THROWS YOU A CURVE YOU EXCEPT IT. I AM JUST TIRED OF THESE FAKES WHO MAKE EVERYTHING HARDER FOR THE REAL HANDICAPPED PERSON. DO NOT EVER TELL ME YOU KNOW HOW IT FEELS BECAUSE YOU HAVE A FAMILY MEMBER WHO IS HANDICAPPED. THAT MEMBER IS ONLY ABLE TO TELL ME HOW I FEEL NOT YOU. I AM JUST SICK OF FAKES THAT IS ALL. DO NOT TELL ME I AM ABLE TO GET OUT EITHER BECAUSE NO ONE OUT THERE WANTS TO HELP.

  • carolinapatriot Oct 28, 2011

    "Would it not be more prudent to, at the very least, scale back the scope of the entitlements rather than add another layer of bureaucracy?"

    So you punish those who do need the services because of the crimes of others? Do you imagine that its impossible for you or a member of your family not to end up in their position?
    --haggis basher--

    Great emotional argument. No, I do not imagine that it is impossible for me or my own to end up in need. But that doesn't mean that I need the government to help me. I would rather live my life on principle and die than make emotional arguments for the government taking someone else's wealth, laundering it through agencies and bureaucrats to preserve my life.

  • LambeauSouth Oct 28, 2011

    I get so angry not being able to get a ramp for my car because I can not afford it yet these people who go golfing and running and bike riding collecting 100 time what I get can make a person very angry and depressed. I had to see a SSI Doctor before they would qualify me so why don't these people.
    barbstillkickin
    October 28, 2011 12:14 p.m.
    OK, I understand your sick, so is my sister, but to throw stuff out such as you stated above is pure fabrication without merit, my sister is housebound (She has MS) and finds ways to occupy here time.

  • seal5050 Oct 28, 2011

    Haggis basher--"I have no issues with stamping out fraud, ironically even if that meant the programs cost more. That way we could remove this claim by the right that all welfare folks are on it because they want to be"

    I agree, while there are some who do fraud the programs like food stamps/EBt, medicaid. I have a cousin who has been severely disabled since birth and the loops her parents go through do to get her what she needs can difficult. There are obviously people who need these services to live. And they should not be punished because of some who do abuse and fraud the government. I know bringing the EBT issue has nothing to do wtih this article, it just reflects some of the fraud I saw have for servies that is costing us as taxpayers. I hope those who do need those services don't get them taken away from them. It is frustrating to see those in need do without while we have some folks cheating the system and costing more money and jeperdizing the program overall.

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