The budget, the veto and Medicaid

The budget, the veto and Medicaid

Sen. Gladys Robinson (Photo by Joe Killian)

Democratic Senator who initially supported the budget says it’s time for the GOP to negotiate

The political stand-off over whether to expand Medicaid is stretching the state budget stalemate deep into summer with no end in site. But this week Sen. Gladys Robinson (D-Guilford) said she’s worried about how the gridlock could hurt the 1.6 million low-income North Carolinians already using Medicaid and undermine planned changes to the system.

The current Medicaid program in North Carolina is complex and expensive, with the federal government paying $2 to every $1 the state contributes to its $14 billion annual cost. But the way that system works is set to undergo a significant change in November.

In 2015, the Republican-led legislature moved to change the way existing Medicaid users access their healthcare. They wanted to shift from the current fee-for-service model, with the state managing and paying for care accessed by North Carolina Medicaid users, to one in which private companies would take over the management of care.

That managed care shift is scheduled to begin November 1.

It is supposed to begin with two of the state’s most populous regions – the Research Triangle and Piedmont Triad areas. Those regions include Wake, Guilford, Forsyth and Durham counties. The second roll-out phase – which will include the rest of the state (including large counties like Mecklenburg and Cumberland) – is scheduled to begin in February of 2020.

But Robinson, a former community health administrator who ran the Piedmont Health Services & Sickle Cell Agency before her election to the Senate in 2010, said the budget stalemate could make that timeline unworkable.

“With 27 counties rolling out in November you’ve got almost a million people who are going to be impacted,” Robinson said. “In Guilford County we have over 100,000 people on Medicaid. And I think people are already confused about the transition and what it means for them. What are we doing to do to help them understand it, to help hospitals and the managed care companies prepare for the transformation? And how are we supposed to pay for that?”

The budget passed by the legislature and vetoed by Gov. Roy Cooper has more than $240 million that is supposed to go into a Medicaid Transformation Fund. Robinson said Republican legislative leaders need to begin negotiating with the governor on a budget he can sign to get the transformation funded and underway.

“The Republicans want to overturn the veto, but they aren’t going to get the votes,” Robinson said. “They need to stop playing games; the Republican leadership needs to stop. They need to come to the table because we need to get this done.”

Pushing the managed care rollout back to at least January seems necessary, Robinson said. The Department of Health and Human Services agrees and lawmakers have filed bills to push back the rollout and provide more than $25 million for IT needs in the transition as part of a stopgap spending measure.

But that’s not a permanent solution.

Robinson said she’s been speaking with groups across the state about the upcoming Medicaid transformation and found that even major hospital groups like Cone Health in Guilford don’t yet know how it’s going to work or on what schedule. Robinson is planning a town hall in August to help educate people about it, but a large number of people are going to have to be made aware of the changes and what they’ll need to do to sign up under the new managed care system.

“A letter just went out to Medicaid beneficiaries telling them they’re going to have to make these changes,” Robinson said. “And I think this is the first a lot of people are hearing about it. What are we doing for folks in advance to prepare people and the providers? When this rollout happens, it needs to be done right and we’re going to need people working to make sure that happens.”

Sorting through and facilitating this big of a change is going to take bodies and hours, Robinson said – and that means money. The communication and rollout hasn’t been great so far, Robinson said – and without a budget in place, it’s unlikely to get better.

And then there are the cuts.

The budget passed in the Senate would cut $42 million from the Department of Health and Human Services over the next two years – a cut Republican lawmakers said would be justified with managed care companies taking over existing Medicaid work. But cuts to the department just as it works to make an immense and complicated shift in how the poorest North Carolinians access healthcare doesn’t make much sense, Robinson said.

Robinson was one of the Democrats who voted for the Senate version of the budget, even with those cuts.

It was a political maneuver, she said – a bid to get more funding for N.C. A&T in the Senate budget that wasn’t present in either the House budget or Cooper’s original budget proposal.

“Once that funding is in there, it’s hard for them to take it out,” Robinson said. “I’ve been around long enough now to know how to do things.”

Robinson always intended to sustain Cooper’s veto, she said – something to which she said she and her fellow Senate Democrats are still fully committed. There have been a few Democrats in the House who have wavered, Robinson said, signaling they would be willing to vote to overturn Cooper’s veto and deal with Medicaid expansion in another session.

One of those Democrats is Rep. Cecil Brockman, a fellow Guilford Democrat whom Robinson said she has counseled to sustain the veto. She said she’s told community members they both represent to reach out to him and all of their senators and representatives to hammer home the importance of expanding Medicaid eligibility to as many as 600,000 North Carolinians struggling to pay for health care.

“This is too important,” Robinson said. “We need to do it and we need to do it now.”