In a year when our state is stashing more than $700 million into surplus funds, the recent state budget appears to target the Department of Health and Human Services for punishment. The budget fails to expand Medicaid, underfunds existing services and makes harmful cuts.
Let’s begin with Medicaid. After years of budget deficits, the legislature pushed our state into Medicaid managed care. Instead of fee-for-service payments, the new model will pay care providers or insurance companies a certain amount of money per month per recipient to provide the services. DHHS has worked diligently to transition to this new model, hopeful it will save money and result in better care for our Medicaid recipients. There will be obvious startup costs with its implementation next year, but the recent budget underfunded Medicaid by some $190 million, $63 million from the state and another $126 million from the federal Medicaid match.
Despite Medicaid expansion alternatives co-sponsored by 22 House Republicans and Speaker Tim Moore, Senate leaders don’t seem interested. The federal government will pay 90 percent of the costs, it will save money, create 40,000 new jobs and 37 other states have already done it. It has the Obama stigma and leadership won’t do something that smells of benefiting the other side.
In the biggest cut in the past 20 years, the legislature lopped $42 million per year in recurring administrative funds from DHHS. An agency spokesperson explained that the size of this cut equals the total amount spent for the Division of Aging and Adult Services, the Division of Child Development and Early Education, the Division of Social Services, the Division for the Blind and Deaf and Hearing Impaired, along with a good measure taken from the Division of Public Health.
If these are the cuts made, they won’t just impact DHHS and its employees, they hurt North Carolinians. Who will inspect nursing homes to ensure patient safety? Who will inspect restaurants to ensure food is properly prepared and served or that our water is safe? Who will provide criminal background checks on child care and child welfare providers? Who will be there when the next health epidemic breaks out? And who will train EMS first responders for the next hurricane or disaster?
But the biggest tell that DHHS is being targeted is the unprompted decision to move the entire Department administration to Granville County. Currently, 11 percent of its staff has a round-trip commute of greater than 90 minutes a day, according to their employee survey. If moved to Granville County that percentage jumps to 85 percent. Does anyone seriously think 85 percent of employees will make this move? And do they further believe we can replace the many professionals and advanced degree specialists, many working below market rates, without a serious loss of service? Services don’t happen without people.
The notorious bank robber, Willie Sutton, once asked why he robbed banks, deadpanned, “Because that’s where the money is.” That seems the most obvious explanation why North Carolina’s Department of Health and Human Services, our largest agency, is being spotlighted. Don’t get me wrong. Any agency spending $20 billion per year can do so more efficiently or effectively and we must get a full measure from every dollar spent. But this just feels vindictive.
We should all hope Gov. Roy Cooper and legislative leaders can find common ground and do what is best for the people of our state.
Tom Campbell is former assistant state treasurer and is creator/host of NC SPIN, a weekly statewide television discussion of issues that airs on UNC-TV. Contact him at www.ncspin.com.