March 16, 2022
Two legislative committees convened on Tuesday to discuss several major healthcare issues in the state, with the Joint Legislative Oversight Committee on Health and Human Services meeting in the morning to receive an update on the state’s pandemic response and behavioral health issues, and the Joint Legislative Oversight Committee on Access to Care and Medicaid Expansion meeting in the afternoon to discuss expansion models in other states.
The Joint Legislative Oversight Committee on Health and Human Services received several presentations from the N.C. Department of Health and Human Services, including an overview of the current state of the pandemic. Secretary Kody Kinsley spoke about entering a new phase of the pandemic due to an increase in vaccinations and treatments, and greater immunity in the community. As the state continues to respond to the pandemic, Secretary Kinsley said that prioritizing equity, maintaining health system capacity and collaborating with local partners will be top of mind. The Department will focus on recovering stronger by investing in coordinated systems of care that make mental health services easier to access, focusing on the health development of families and children to build more resilient families, better educational outcomes and a stronger society, and building a strong and inclusive workforce. Secretary Kinsley also discussed the current state of emergency order in place, and explained why the order was still needed to allow healthcare licensure and regulation flexibility, along with allowing the state health director to issue standing orders for testing and treatment as needed.
The committee also received an update on the Department’s budget. Due to the transition to managed care, uncertainties from the pandemic and actual enrollment exceeding projections, Medicaid expenditures will slightly exceed budget appropriations this year. Through January, NC Medicaid has expended a higher percentage of total budget than at the same point last year. However, Medicaid is only one piece of the budget and NCDHHS expects to manage the shortfall with other resources. The pandemic had a significant impact on NCDHHS’ budget, and the Department continues to administer funding for programs through the 100+ federal funding streams and allocations that North Carolina has been awarded to address needs specific to the COVID response. Looking forward, NCDHHS continues to need support for testing, vaccine administration, behavioral health services, family and children, and healthcare workers.
NCDHHS also presented on the behavioral health crisis in North Carolina. Uninsured people use emergency departments for behavioral health issues at a rate of 4 times higher than insured people. Although those who are uninsured make up about 13% of the total population, they make up 36% of emergency department visits for behavioral health needs. Behavioral health patients end up stuck in the emergency department for a variety of reasons, and to alleviate this issue the Department is focusing on comprehensive integrated care models, support services in communities across the state, and investing in workforce development to increase the number of behavioral health providers. NCDHHS asked the legislature for sustained funding for crisis and community-based services and overall rate increases for behavioral health. Medicaid expansion is also a top priority in order to mitigate this growing issue.
The committee heard other concerns about the behavioral health crisis from Cory Hess, President and CEO of Harnett Health. Hess outlined several major issues with the current behavioral health system in North Carolina, and urged lawmakers to invest in crisis care and Medicaid expansion, increase access to telehealth services, ensure adequate care networks and incentivize health systems to continue to invest in this patient populations. Mark Botts from the UNC School of Government also gave an overview of the involuntary commitment (IVC) process for behavioral health patients.
The Joint Legislative Oversight Committee on Access to Care and Medicaid Expansion met later in the afternoon to learn about different models of Medicaid expansion in other states. The committee received presentations on Medicaid expansion programs in Montana, Ohio, Indiana and Michigan. All four states had Republican-controlled legislatures when they expanded Medicaid. Common themes among the states’ Medicaid expansion programs included a decrease in uninsured patients, a decrease in uncompensated care, improved health outcomes and access to primary care providers, increased utilization of telehealth services – especially for the behavioral health population, and more providers participating in the Medicaid program to meet the higher health services demand.
States also saw a positive economic impact when they expanded Medicaid, with general fund savings, additional dollars flowing to local communities, and an increase in federal funds returned back to states. Work requirements for the expansion population continue to be a topic of interest for North Carolina legislators, despite being thrown out by a federal judge in other states. Montana, Ohio, Indiana and Michigan all attempted to incorporate work requirements into their original Medicaid expansion plans, but they have since been suspended or were never enacted.
The committee also received a presentation from Casey Cooper, CEO of the Cherokee Indian Hospital, on how Medicaid expansion would impact Western North Carolina and specifically the Eastern Band of Cherokee Indians (EBCI). Cooper said that failing to address the coverage gap could be disastrous for the Indian Health Service and Tribally managed health systems. Indian Health is among the most underfunded federal health systems in the country and Medicaid is used to help cover the cost of providing health care for this population. The EBCI estimates between 1,000 and 1,400 patients are below 138% of the Federal Poverty Level and do not have coverage. Cooper explained that expanding Medicaid would also help sustain rural hospitals in Western North Carolina who struggle to pay for uncompensated care.
The Joint Legislative Oversight Committee on Access to Care and Medicaid Expansion plans to convene again on Tuesday, March 29th at 9:30 a.m. to discuss how full practice authority for APRNs would increase access to care.