The House’s 2010-11 budget recommendations would include total Health and Human Services (HHS) spending of $5.04 billion, once more than $1 billion in federal stimulus funds are factored in. The House plan appears to spend $3.97 billion, but the more than $1 billion in federal funding – mostly for Medicaid – appears in the state budget as a “cut,” and therefore does not accurately reflect the actual amount being spent on state HHS programs.
One particular sticking point of the House plan is that it relies on roughly $500 million of anticipated federal Medicaid funds that have yet to be confirmed for disbursement.
The House budget plan also includes an additional $430 expansion of state Medicaid appropriations to accommodate unanticipated growth in the program. This expansion is in addition to the $273 million expansion already planned for in the biennial budget approved last year.
On net, the House budget plan would reduce the previously approved 2010-11 HHS appropriations by $351 million. The House budget proposal is different from the Senate’s and Governor’s proposals in several ways. The House proposes to increase funding for NC Health Choice, a state-funded health insurance program for children from low-income families that make too much to be eligible for Medicaid, by $3.3 million – an amount significantly less than the Senate’s expansion of $6.5 million and the Governor’s $8.5 million. The House also differs with the Senate and Governor budgets regarding the in-home Personal Care Services (PCS) program. The Senate and Governor sought to eliminate the program, which provides assistance to seniors with everyday activities like cooking and bathing, and replace it with a program focusing only on those “with the most intense needs”. Conversely, the House wishes to keep the program intact but find $34.5 million in savings from “independent assessments” of caseloads intended to root out unnecessary care.
Major expansions and reductions include:
- $430.5 million: Further increase of General Fund appropriations to Medicaid budget to accommodate a previously unanticipated 5.6 percent expansion in newly eligible individuals
- $14.2 million: Additional funding to increase enrollment in the AIDS Drug Assistance Program
- $3.3 million: To expand enrollment in the NC Health Choice program
- $1.6 million: Additional state funding for rural hospital operations and maintenance
- $489.8 million: Itemized as a reduction in state spending because it is expected the federal government will replace the state spending through an extension of a federal matching fund program enacted in the American Recovery and Reinvestment Act (ARRA) for six months
- $79.4 million: expected savings in Medicare part D through federal funding ARRA
- $34.5 million: Reduction to Personal Care Services due to “independent assessments” designed to eliminate unnecessary care.
- $23.6 million: Replaces state funded child care subsidies with federal Temporary and Needy Family (TANF) emergency contingency funding
- $28 million: Savings desired from “care management programs” administered through Community Care Network of North Carolina (CCNC) which manages much of the Medicaid program
- $10 million: in expected savings by adding mental health drugs to the Preferred Drug List
- $41 million: in expected savings from management changes in Enhanced Mental Health Services
- $36 million: in expected savings through Program Integrity Initiatives to reduce fraud and waste in Medicaid