Gov. Josh Stein made an urgent plea to the General Assembly Thursday afternoon to put aside their political disputes and fully fund the Medicaid rebase as the deadline to do so quickly approaches.
“It is not too late for them to step up and do the right thing,” the governor said at a press conference at Alliance Medical Ministry in Raleigh. “I’d hope that the legislature would realize that helping people get the health care they need is more important than grinding their political axes, but so far they haven’t.”
Unless the Medicaid program gets extra funding by Oct. 1, there will be cuts to Medicaid reimbursement rates.
Alliance Medical Ministry is a free and charitable clinic serving uninsured working adults in Wake County who don’t qualify for Medicaid and cannot afford private insurance.
“Every doctor visit here, every counseling session here is funded by community philanthropy,” said Pete Tannenbaum, Alliance’s executive director. “So, here’s why proposed Medicaid cuts are so concerning to us. Alliance is one of the few clinics in North Carolina’s health care safety net that doesn’t take Medicaid, so we’re bracing for a surge of newly uninsured patients with nowhere else to turn.”
He said similar clinics across the state are worried about the possibility of 700,000 North Carolinians losing their health care if they leave the Affordable Care Act marketplace due to the potential loss of subsidies that will make it unaffordable.
Stein, a Democrat, said that the North Carolina Department of Health and Human Services has determined that $319 million is needed to fully fund the Medicaid rebase, even though both the House and the Senate agreed only $190 million would be needed in their separate bills, based on analysis by the General Assembly’s Fiscal Research Division.
But that would be okay, for the time being, according to the governor.
“I directed DHHS and Medicaid to identify cuts that were reversible,” he said. “What does that mean? It means that our representatives and senators can come together on a deal, undo these cuts in the month of October, so that’s my request that the House and the Senate come together and put your differences aside.”
The governor said another option would be to use some of the $500 million in the Medicaid Contingency Reserve that is available for the legislature to appropriate today.
The House version is being called a “clean bill” with nothing added. The Senate version includes things like the North Carolina Children’s Hospital, even though it was agreed on in the budget in 2023.
“This is a crisis that we are facing in just a few days,” Rep. Grant Campbell, R-Cabarrus, who is also a physician, told the House on Tuesday. He told the House Rules Committee earlier in the day that the Medicaid rebase has been increasing at a fiscally unsustainable rate for several years, with double-digit percentage growth becoming a regular occurrence.
He added that those who care about it being a “clean bill” include hospitals, doctors, nurses, dentists, psychologists, and others in the medical field, but most importantly, those who are sick and their families.
“The proposed cuts are severe, and they are scheduled to begin next week, anywhere from 3 to 10% for things like hospital stays, primary care, dental care, behavioral health. And I could go on and on,” Campbell said. “There are health care providers all over the state that are already planning layoffs, and some are trying to decide whether to even continue seeing Medicaid patients at all.”
He also said that the cuts don’t have to happen next week, because NCDHHS would not run out of funding before the short session next year, as they were already provided with $600 million in extra funding, more than enough to get to the mark where they could adjust the rebase as needed.
Campbell was also critical of the actions of Stein and the Senate.
“There’s time to do this right, but the governor has decided, with very little notice, to threaten not us, but the North Carolina residents needing health care, with massive cuts that will begin months before they have to,” Campbell said.
Stein disagreed.
“Some have said that DHHS can avoid instituting these cuts or that DHHS can delay the cuts,” he said. “Unfortunately, it cannot. The state constitution requires the state to have a balanced budget. DHHS cannot spend money that it does not have.”
Jay Ludlam, deputy secretary for North Carolina Medicaid, stated that this past fiscal year, which ended on June 30, the Medicaid program ended with $9,000 in its account after spending $34 billion.
When questioned why he would not push the Oct. 1 deadline back to Oct. 20, when the General Assembly is anticipated to return for a full session, Stein said he fears legislators will do exactly what they did on Sept. 25.
“If we put the cuts off for a month, then they’re going to say put it off for another month, because we’re actually coming back in November, then you only have seven months to make up these cuts instead of nine months,” he said. “Like I said, we’re already done as we played this game on July 1.”
Stein would later add during a question-and-answer period with reporters that the legislature has not fully funded Medicaid in six or seven years, but this year is different because there is no federal source of funds to make up the difference.
He said that he and the General Assembly have worked together before on things like reducing wait times at the Division of Motor Vehicles and recovery efforts in western North Carolina after Hurricane Helene, and that they should work together again on funding the Medicaid rebase.