Raleigh, N.C. — Medicaid appears to be a major difference between the House and Senate state budget proposals that will have to be worked out before the 2014-15 fiscal year starts in three weeks.
The Senate slashed Medicaid benefits to the minimum federal requirements, which would eliminate coverage or eligibility for about 15,000 elderly or disabled people statewide as of Jan. 1. The Senate budget also ordered a halt to all Medicaid reform efforts – senators want to create a new agency to oversee the insurance program – and move toward a managed care model.
The House jettisoned both of those ideas in the spending plan rolled out Tuesday. Current eligibility requirements would remain, and $1 million would be set aside to continue studying ways to reform Medicaid, which has been a money hole for the state in recent years.
Under the House proposal, the Medicaid director would be appointed by the governor and approved by lawmakers to serve a five-year term.
Also, House budget writers call for ending the program that divvied up any Medicaid cost savings between the state and providers. The state would keep 3 percent reimbursements from a variety of providers, except from nursing homes.
Other highlights in the Health and Human Services portion of the House budget include the following:
- The eligibility requirements for child care subsidies are narrowed, and fiscal analysts said that would knock about 12,000 of the 110,000 children served each year under the program off the rolls. Families still receiving subsidized care have to make a co-payment equal to 10 percent of their income.
- Funding for North Carolina Pre-K would expand by $9 million, helping move hundreds of children off wait lists statewide. Also, more lottery money would be used to fund the pre-kindergarten program instead of $49 million in General Fund money.
- Doubles the funding to Child Protective Services, to $27 million, to add case workers at the county level and provide additional training and state oversight. Foster care assistance also would expand to keep up with a growing caseload.
- After recent media reports to troubles in the state medical examiner system, both the House and Senate budgets set aside $1 million to upgrade the system. The House plan also says the state's chief medical examiner no longer would have to accept local recommendations when appointing county medical examiners.
- The House would restore 70 school nurse positions cut in the Senate budget. It also would cut a Senate provision to close the Wright School in Durham, which serves children with behavioral and emotional disorders.
- Teens 17 and younger would no longer be able to use tanning beds. The House passed a bill with similar language last year, but it has languished in the Senate, even though the tanning industry now supports the move.
- To discourage people with mental health or substance abuse problems from being taken to hospital emergency rooms, $5 million was set aside to expand community-based crisis intervention services.
"I like this budget much better than the last time we were together going over a budget," said Rep. Beverly Earle, D-Mecklenburg.
Despite the fact that Health and Human Services is the second-largest chunk of the state budget behind education, only seven House members attended the appropriations subcommittee meeting Tuesday to review the spending plan. Only three minor amendments were offered before the budget was approved.