Senate leaders pit support for disabled against Medicaid expansion

The bill filed Tuesday would add $41 million in state funds to increase IDD slots in the state from 12,000 to 14,000. Those slots provide a range of supportive services, from housing to employment assistance, making it easier for IDD adults to live independently.

Sponsor Sen. Joyce Krawiec, R-Forsyth, said about 12,000 people are currently on the IDD waiting list, and the average wait time is seven to nine years.

“It is crucial that that population is taken care of first. Democrats keep focusing their agenda on reducing the number of the uninsured but not increasing access to care,” Krawiec said at a news conference. “We just believe they should be taken care of first before we talk about any other expansion.”

The legislation contains an array of other changes, including the near-immediate elimination of North Carolina’s Certificate of Need program, a longstanding goal of Senate leaders. It would also eliminate state regulation of the Medicaid elder-care program known as PACE, citing duplicative federal licensing requirements.

It would also enter North Carolina into PsyPact, an interstate compact that allows mental health providers licensed in one state to provide services to patients in other states, either in person or via telemedicine. Seven states have already agreed to take part, but most are in the West and Midwest. None of North Carolina’s neighboring states have yet signed on.

Asked why the state could not simultaneously add IDD slots and expand Medicaid, co-sponsor Sen. Dan Bishop, R-Mecklenburg, said “resources are always limited,” and legislators have to prioritize.

Bishop added that the expansion has cost states like Ohio much more than anticipated, and he predicted that federal funding for the match for Medicaid expansion will decrease soon under the weight of the growing national debt.

“Gravity will reassert itself at some point,” he said. “It is, frankly, a reckless approach.”

Bishop said the state’s Certificate of Need program is the fourth most restrictive in the country. It was created under federal mandate in 1987 as an attempt to reduce ballooning health care costs by preventing hospitals from adding expensive equipment or programs local markets don’t need. However, he said, it’s reducing competition and increasing patient costs.

The elimination of CON laws has long been advocated by conservative groups, including Civitas and the John Locke Foundation. Senate leaders have made similar proposals every session since 2011, but so far, the state House has declined to consider them.