Brisson: Budget Differences Not Easy to Resolve | Eastern North Carolina Now

    Publisher's note: The author of this post is Dan Way, who is an associate editor for the Carolina Journal, John Hood Publisher.

Medicaid overspending, though, might not be an issue this year


    RALEIGH - There are "widespread differences" that are "not what you would call easy" to resolve between House and Senate health care budgets, is state Rep. William Brisson's assessment of budget deliberations in the N.C. General Assembly.

    "It's going to take time, and a lot of hard work, a lot of persuasion" to reconcile the plans," The Bladen County Democrat he said.

    However, Medicaid overspending might not be a complication this year, as it has been in recent years.

    "For the second straight fiscal year the North Carolina Medicaid program ended the year with cash on hand without needing additional appropriations," state Department of Health and Human Services spokeswoman Alexandra Lefebvre said without specifying any numbers.

    "Year-end results will be released when the budget close-out process is finalized," Lefebvre said.

    The House budget would appropriate $5.3 billion in 2015-16 for Health and Human Services, and $5.4 billion in 2016-17. The Senate budget is lower, at $5.1 billion in 2015-16, and $5.2 billion in 2016-17, leaving a difference of $223.4 million next year, and $223.7 million in 2016-17.

    "There's a big difference in the House and Senate budget right now, different ideas, and different issues," Brisson, chairman of the House Appropriations Committee on Health and Human Services, said after a meeting on Wednesday.

    Brisson is hoping budget negotiations will be completed before Aug. 14. That is the expiration date for the continuing budget resolution passed by both chambers to keep government operating beyond its June 30 fiscal year.

    "There will be some give and take, but the House is pretty solid right now where we are at in the money that we appropriated for Health and Human Services, and we have a pretty good showing of where we need the money," Brisson said. "If they [the Senate] can help find us savings, we'll employ it."

    In recent years huge budget overruns in Medicaid have caused ripple effects in dealing with other areas of the budget.

    "It's probably too early to determine that," Brisson said of whether Medicaid would come in under budget for the just completed fiscal year. "Back on the first of April we ran a couple of hundred million short."

    "It's too early to tell just yet. It's probably going to be about another month because of the cash difference, and some wrap up work that needs to be done over there" at DHHS, said Sen. Louis Pate, R-Wayne, co-chairman of the Senate Health and Human Services Appropriations Subcommittee.

    "In May they were in the black at the time, but that's all got to be sorted through to see what they were at the end," Pate said. "It could change in the bat of an eye."

    As it was last year, "Medicaid reform probably is the biggest issue" in reaching agreement on the two health care budgets, Brisson said. That was the major sticking point in budget negotiations that delayed an agreement last year.

    "They're rolling the ball around, kicking the ball again. It might be a little stronger from the other side this time," he said.

    "Right now we're in favor of keeping it in the state and under the state" through networks of doctors and hospitals covering at least 30,000 individuals, Brisson said. A network may cover just one demographic region of the state, but contracts in aggregate must cover the entire state. A new Legislative Oversight Committee on Medicaid would monitor the program.

    The Senate plan would offer three statewide contracts, and up to 12 regional contracts in six regions established by a Health Benefits Authority that would assume control of Medicaid from DHHS. Both provider-led networks and managed care organizations would be eligible for the competitive contracts.

    The Senate Medicaid reform proposal includes all Medicaid beneficiaries except dual-eligible categories for whom Medicaid pays only Medicare premiums. The House version covers only 90 percent of all Medicaid beneficiaries, and excludes dual eligibles. The Senate plan would be fully implemented in two years. The House plan would roll out over five years.

    Both budgets call for the networks to offer full-risk, capitated health plans, alleviating the state taxpayers of the burden of paying Medicaid cost overruns.

    The Senate Medicaid reform plan discontinues the longstanding primary care case management contract with Community Care of North Carolina, which has administered Medicaid for the state under a fee-for-service system. The CCNC contract is set to expire Dec. 31.

    The Senate plan would use the savings from ending the CCNC contract to increase rates to primary care doctors and OB-GYNs to 100 percent of the Medicare rate. That is intended to lure more doctors into the Medicaid networks.

    It is not certain whether CCNC would attempt to set up its own network under the Medicaid reform or possibly seek a contract to create a statewide electronic health records program. A call to the agency was not returned.

    The House budget appropriates $3,160,611 in both years of the biennium to transfer any contracts to DHHS in the event the existing North Carolina Health Information Exchange is dissolved.

    The Senate directs use of $8 million in each of the next two years to establish a successor to be known as the North Carolina Health Information Exchange Authority. It would have an advisory board to provide consultation, and the authority would be 100 percent fee supported.

    As a condition of receiving state funds including Medicaid money, hospitals with electronic records systems, Medicaid providers, and all providers that receive state funds for provision of health services would be required to participate in the electronic records network.

    The goal is to connect all Medicaid providers to the network by July 1, 2017. All others receiving state funds would be connected by July 1, 2018.

    Sherry Bradsher, deputy secretary of DHHS, urged House members not to change course on the NC Fast program, which allows the agency to coordinate case management with the 100 county departments of social services.

    The Senate budget calls for $5.8 million in 2015-16, and $13 million in 2016-17 to purchase a child welfare case management system. It would be separate from NC Fast, but able to interface with it. The House budget does not include the item.

    "We have spent a lot of time since January with our county departments of social services, specifically our child welfare staff, in order to assure our requirements are where they ... need to be, for a successful implementation of child welfare into NC Fast," Bradsher said.

    "If we change direction, one of the things we have to weigh is what have we already spent, what will we have to spend, and then justify what improvement ... would be worth changing the horse in the middle of the stream," said Rep. Marilyn Avila, R-Wake, vice chairman of the HHS Appropriations Committee. She said she wanted to see the cost-benefit numbers.
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