Medicaid services not required by the federal government but approved by the state legislature in years past cost $4.4 billion in 2010-2011. That accounted for 46 percent of the $10 billion Medicaid budget. North Carolina’s Medicaid program was referred to as a “Cadillac” program in a study by the Lewin Group a few years ago.
The most expensive of the optional services include:
- Prescription drugs: $1.1 billion
- Community alternative programs: $809.6 million
- Mental health: $752.7 million
- Intermediate care facilities: $482.1 million
- Personal care: $436.7 million
Other optional services include adult dental care ($143.3 million), physical, occupational and speech therapies ($84.6 million), private duty nursing ($69.2 million), hospice care ($66.6 million), case management ($73 million), transportation ($47.6 million), orthotics and prosthetics ($19 million), routine adult eye exams ($8.4 million), podiatry ($5.5 million), adult visual aids ($5 million), chiropractor ($1.5 million) and hearing aids ($96,303).
Health and Human Services budget writers at the General Assembly have been told there is about a $150 million shortfall in funding to meet expected Medicaid expenses in the 2012-2013 fiscal year. North Carolina could also come up short nearly $400 million more if the state loses a legal quarrel with the federal government over personal services.
House Health and Human Services budget committee chair Rep. Justin Burr (R-Stanly) says that despite the search for savings, optional services won’t be cut or eliminated.
Burr’s committee was given an adjusted budget target that was $63 million lower than the appropriation for the 2012-2013 fiscal year.
Some lawmakers say no one is going to cut services during an important election year. Health care providers aren’t taking any chances. They want to make sure they are part of the conversation. Members of the Legislative Oversight Committee on Health and Human Services, for example, received a total of about $300,000 in campaign contributions in 2010-2011 from medical interests.
That’s not unusual. Democrats received large contributions from health care providers when they wrote the budget. Also some of the committee members are also members of the medical industry, so routinely receive support from colleagues.