News: CJ Exclusives

McCrory Announces Limited Medicaid Expansion

$300 million will boost funding for services targeting mental health, children with autism, adults with developmental disabilities, substance abuse, other services

Gov. Pat McCrory announces new services covered by Medicaid at a Monday press conference. (CJ photo by Dan Way)
Gov. Pat McCrory announces new services covered by Medicaid at a Monday press conference. (CJ photo by Dan Way)

Gov. Pat McCrory announced Monday that he plans to expand the state’s Medicaid rolls in several limited areas as part of his Health and Human Services budget priorities, and will continue to seek broader expansion from the White House.

McCrory outlined at least $6.6 million in new funding for Medicaid services, and state Health and Human Services Secretary Rick Brajer said some of that state funding would be matched by federal dollars, all of which could reduce overall Medicaid spending by providing services to people in need in a less expensive manner.

The governor outlined his health budget during a news conference at the executive mansion, surrounded by lawmakers, advocacy organizations, DHHS staff, and 11 law enforcement and EMS first responders.

McCrory proposed $30 million for a variety of expanded services for mental health and substance abuse, based on recommendations of a mental health task force he commissioned.

“And this is just the beginning, because we’re going to have to make more investments in substance abuse and also mental health because it’s an issue that’s being hidden in our emergency rooms, in our county jails, and in our state prisons, and underneath bridges across North Carolina,” McCrory said. Referring to his initial State of the State address, the governor said, “I made that commitment that we will no longer ignore that issue.”

The budget also includes $8.6 million for enhanced child protection services, and increasing early childhood programs by expanding pre-K slots for 400 at-risk 4-year-old children at a cost of $2 million, expand drug courts and military courts.

His budget proposes increased funding for medication-assisted treatment and access to Naloxone, a life-saving drug administered for heroin or opioid overdoses.

“This is a life and death matter,” McCrory said. “People are living and dying based on whether or not they have access to this drug.” He said Guilford County experienced 24 overdoses and five deaths in a 24-hour period in 2014. After Naloxone was given to all of the county’s first responders it has been administered in more than 600 cases.

The governor recognized Guilford County Sheriff’s Deputy Matt Stalls, who saved two lives within four hours using Naloxone.

“I realize there are issues regarding Medicaid, and my major priority is to help those who can’t help themselves, and encourage those who can. That is the philosophy of this campaign,” McCrory said.

The piecemeal approach is being pursued because a full-blown Medicaid expansion was rejected by President Obama.

“I have personally met with the president of the United States in the Oval Office to talk about possibly getting a waiver for Medicaid expansion” that would require work or training requirements for new participants, McCrory said. “The president disagrees with that waiver, and therefore he’s rejected that kind of waiver.”

He said he was going to “keep approaching the administration about waivers which would encourage people to also help themselves” while receiving government benefits and health services.

McCrory’s announcement comes just days after two key senators told Carolina Journal they did not see any desire among the Republican caucus to expand the federal insurance program for the aged, disabled, and poor beyond its current level, which consumes 17 percent of the state budget.

“We are learning to do a better job with Medicaid, but we’re not ready to open it up to a great number of new policyholders,” said Sen. Louis Pate, R-Wayne, chairman of the Joint Legislative Oversight Committee on Health and Human Services, and a member of other health care committees. Pate was among legislators at McCrory’s press conference.

Sen. Ralph Hise, R-Mitchell, chairman of the Joint Legislative Oversight Committee on Medicaid and NC Health Choice, said if the Obama administration rejected McCrory’s pitch for adding work or training requirements to Medicaid expansion, “then we’re in a good position now where we’re at with Medicaid, and that has not changed with any legislator that I’ve had discussions with.”

Based on feedback he has received from other legislators, Hise said, “there have been no changes in direction. The federal government has not changed. The only change I see coming is that in January we’ll have a new administration to work with one way or another, and we can move forward at that time with hopefully what we believe the Medicaid system of North Carolina should look like” after the presidential election.

State Budget Director Andrew Heath told Carolina Journal after McCrory’s press conference that his office is still “fine-tuning with the numbers, “but we feel pretty confident saying there’s going to be between $275 million and $325 million in availability that is there from Medicaid [recalculations]. It’s driven by a decrease in enrollment, and a decrease in utilization.”

Medicaid enrollment is still expanding, he said, but at a rate lower than expected.

“The $30 million that we’re going to funnel into the governor’s mental health task force, that availability is linked to the Medicaid rebase,” Heath said.

He said the rest of the budget areas McCrory is working on “looks good.”

“It’s an expansion budget,” Heath said, “but it’s going to be a very conservative spend[ing] figure. We want to be mindful of being able to invest into the rainy day fund so that we have savings reserves. But we feel confident that we’ll be able to fund every one of the items that were discussed today.”

“I’m going to make sure our money goes to those people who can’t help themselves, and that’s including those with Alzheimer’s,” McCrory said. His budget would add $3 million to fund an additional 320 slots for community alternative programs for disabled adults through Medicaid to address critical needs facing families for in-home services.

“Let’s keep them in their homes as long as possible. The new slots will reduce waiting lists for these important services,” McCrory said. “Believe me, you can’t help yourself when you have Alzheimer’s. And we want to expand Medicaid services to those who do have Alzheimer’s,” he said, referencing his mother’s nearly 12-year battle with the disease.

Another $1 million in increased family caregiver support, including respite care, is part of his Alzheimer’s proposal.

His proposal would expand Medicaid services for children with autism and adults with developmental disabilities.

“These children have a future now, and they have hope, and we need to help them get on their feet, and help their parents,” McCrory said.

He is calling for $2.6 million for 250 Medicaid innovation waiver slots for people living with development disabilities to lead successful lives in the community.