2017 state budget: Health and human services

Of all the differences among the three budgets submitted for the upcoming two-year spending cycle, none is larger, and less likely to be negotiated, than the $4.4 billion Medicaid expansion Democratic Gov. Roy Cooper is pushing.

Cooper contends the provision, which would add 624,000 people to the Medicaid rolls — nearly a third of the 1.97 million currently enrolled — would cost state taxpayers nothing because hospitals and the federal government share would pay for it. About one in five North Carolina residents now are on Medicaid.

The Republican-led House and Senate adamantly oppose expansion, and do not include it in their budgets. Cooper’s request to expand Medicaid is stalled in Washington.

Republicans say other states that expanded Medicaid, thinking others would pick up the costs, have wound up with major budget deficits.

Here are other key components of the health and human services budgets:

•  Cooper’s recommended HHS budget is $5.34 billion in 2017-18, and $5.48 billion in 2018-19, with the potential Medicaid expansion adding $4 billion to total spending. The House budget would allocate $5.24 billion in the first year, and $5.41 billion in the second. The Senate version has $5.23 billion in the first year, and $5.34 billion in the second.

•  Cooper’s 2017-18 budget allocates $3.73 billion to the Division of Medical Assistance, which administers Medicaid. He sets aside $3.86 billion in 2018-19. The House budget is $3.67 billion in 2017-18, and $3.79 billion in 2018-19. The Senate budget is $3.68 billion in 2017-18, and $3.8 billion in 2018-19.

•  The Senate budget phases out certificate-of-need laws, which require state approval to purchase large medical equipment or to set up freestanding clinics for a host of medical procedures. The budget includes other more targeted CON repeals. Neither the governor nor the House include those provisions. “We believe that that is a major policy issue that is best addressed through the normal legislative process, and the normal committees outside of negotiation in the budget process,” said Rep. Nelson Dollar, R-Wake, the House chief budget writer.

•  Cooper’s budget directs $12 million in community mental health funds to treat opioid addiction. The Senate would provide $2 million for a pilot program in some parts of the state. The House would increase a provision for opioid overdose treatment by $100,000, and put $250,000 into a law enforcement pilot program in Wilmington.

•  The Senate adds $75 million in each of the two budget years into a Medicaid Transformation Fund created in 2015. Dollar said the House budget would reallocate a like amount from existing funds. Cooper’s budget does not appear to include the funding. The Transformation Fund will cover the cost of shifting Medicaid from a system paying medical providers a fee for each service delivered to a flat monthly rate per member, and for unforeseen costs if the Trump administration approves Medicaid expansion.

•  Both the House and Senate 2017-18 budgets increase inpatient mental-health beds by using money from the sale of the Dorothea Dix campus in Raleigh. It does not appear the governor’s budget includes that provision. The Senate allocates $1.8 million for renovation or construction at the Dix Crisis Intervention Center in Onslow County. Another $6.2 million is set aside to pay for renovation, construction, or conversion of inpatient beds to behavioral health beds at rural hospitals chosen by the DHHS secretary. The House budgets $19 million from the Dix Hospital sale to increase behavioral health inpatient bed capacity at five selected hospitals, $2 million for a case management pilot program in Wake County, and $2 million for competitive grants to establish crisis facilities for children and adolescents.