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    North Carolina 2014 Short Session, Week 8: Medicaid Budget Miracle

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    Social workers found victory during the eighth week of the legislative short session with the acceptance of the proposed medicaid budget. On Monday night, the last day of the fiscal year, the Senate rejected the House mini budget, Senate Bill 3 without even voting, and they returned the bill to the House for further consideration. In kind, the House then returned the bill back to the Senate on Tuesday stating they did not follow the rules by rejecting Senate Bill 3 without a vote. This unusual game of ping pong with the budget sent the bill to a committee meeting with the appointed budget conferees and no further discussion happened on the floor of the House or Senate.

    MiraclesOn Wednesday, the appointed 41-member budget conferees held an unusual open-to-the-public meeting. During the meeting, differences in the House and Senate budgets were discussed and the group broke into a private negotiating meeting. Upon return to the public meeting, the Senate announced that they would accept the House Medicaid budget with a few compromises that had been made before the meeting starting.

    The acceptance of the Medicaid budget means the aged, blind, and disabled citizens on Medicaid will not lose services. We are excited the Senate acted on behalf of our advocacy efforts to save services for these populations. While the Senate agreed to the Medicaid spending, the conferees are still working out differences in teacher pay raises, the education lottery, and film incentives.

    Bills with Relevance:

    • House Bill 1181 North Carolina Medicaid Modernization: This bill was introduced a few weeks ago with controversy in Section 10 regarding a pilot for I/DD patients living in certain group settings to have integrated physical and behavioral health care under Cardinal Behavioral Health. Under the new edition, this section becomes a study with multiple stakeholders involved. The bill was discussed in committee and passed the House with a vote of 113 to 0. The bill now goes to the Senate where support is underwhelming as Senators do not believe this plan, supported by the House and the Governor, will do much to make Medicaid a cost predicting system.
    • House Joint Resolution 1262 Suicide Prevention Resolution: On Wednesday, House members read the suicide prevention resolution on the floor. The resolution directs the Legislative Research Commission to study ways to prevent suicide among minors and veterans including training for key health care providers that work to assess, treat and manage patients with suicidal ideation. After overwhelming, bipartisan support from legislators who shared personal stories on the floor, the bill passed with no opposition and was sent to the Senate. Following the reading of the resolution, NASW-NC, NAMI-NC, The Mental Health Association, and others were recognized in the gallery by legislators for our support and continued work on suicide prevention in our state. Representative Cunningham (D-Mecklenburg), a primary sponsor of the legislation, gave a heartfelt, personal speech on the bill and credited social workers and educators for help during her family’s situation. We are grateful to the many legislators who stood up to speak on what can be such a tough topic for many.

    What to look forward to this week:

    Legislators have announced they are finished with committee work. They will use this week to focus on the budget and work out their differences. There are a few more bills expected to be heard on the floor this week but it should mostly be a quiet week with budget work being done behind closed doors.

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    Kay is the Director of Advocacy, Policy and Legislation and registered lobbyist for the National Association of Social Workers, NC Chapter. She spends her time at the North Carolina General Assembly and in over 30 statewide coalitions advancing and advocating for the social work profession. Kay's legislative updates are provided by the National Association of Social Workers, North Carolina Chapter (NASW-NC). NASW membership supports advocacy efforts on behalf of social workers and their clients at the state and national level. Become a member of your professional association today by joining online at www.socialworkers.org.

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    The True End to the 2014 NCGA Short Session

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    legislative building

    Legislators finally adjourned for the 2014 short session on Wednesday, August 20th which is almost seven weeks after originally anticipated. You may recall my Week 12 update where I claimed that week was a wrap but it did come with a catch. Legislators wanted time to decide if they needed to come back in November for a special Medicaid and/or Coal Ash Session as well as take up any number of other provisions. By law, legislators had to continue meeting every four days while leadership decided what to do. Legislators held skeleton (or no vote) sessions until they came back on Thursday, August 14th to really wrap up the short session.
    Relevant bills with action

    After a few committee meetings, Senators created 3 adjournment bills hoping the House would pass at least one of them:

    House Joint Resolution 182 Adjournment Resolution: a bill that would end session but come back in November for a special Medicaid Reform short session.

    House Joint Resolution 901 Adjournment Resolution: a bill that would end session but come back in November to discuss Medicaid Reform, conference committee reports, and a few other measures.

    House Joint Resolution 1276 Adjournment: the winning bill that ended session with no plans to return in November. Unless the Governor calls legislators back for a special session, we won’t see legislators passing bills again until the 2015 long session which will start in January.

    Legislators also wrapped up a few bills that were awaiting concurrence. Of interest to social workers:

    House Bill 369 Criminal Law Changes was passed by both the House and the Senate and presented to the Governor for signature. The bill makes several changes to various criminal laws. Most pressing, section four of the bill directs the North Carolina Human Trafficking Commission to work with various organizations, including NASW-NC, to study and develop age appropriate sexual abuse education to be taught in schools to students and educators.

    Now that session is truly done for the short session, NASW-NC will now focus on work with our Political Action for Candidate Endorsement Committee (NC PACE) on endorsing candidates that support the social work profession. Through these endorsements, we hope to elect social work friendly candidates that can help advance our profession and support the clients we serve.

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    2014 NC Short Session: That’s Hardly a Wrap!

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    Senators wrapped up the 2014 short session shortly after a midnight on Friday when they finally approved a state budget. House members  followed by issuing their final votes on Saturday. But there’s a catch, legislators will return this week to agree on an actual adjournment date as the House made more changes to the Senate’s original plan.

    On August 14th, legislators will return for a brief additional session to take up any bills that might get vetoed by the Governor, wrap up any bills that got assigned to a conference committee, and attempt to complete nine different other provisions held over in adjournment resolutions. There’s still one more catch, legislators will return again on November 17th for a special session to discuss Medicaid Reform and possibly Coal Ash, and there is no word on how long this session will last.

    So, while legislators have adjourned, they have not technically finished working. We should have a better idea of  their plan to meet again in August by the later part of this week.

    Relevant Bills with Action:

    SB 744 Appropriations Act of 2014: This bill has been in the works since session started. When legislators couldn’t agree, they turned to appointing a 42 member conference committee. Last weekend, they reported that they had come to an agreement. The conference committee budget highlights are below. With the Governor’s signature, this will be the state budget for the 2014 fiscal year. View the Money Report for further explanation on the spending plan with accompanying page numbers listed after each highlight. Please note, it is difficult to capture all the provisions in the budget due to the amazing variety of the social work profession so information below is only a snapshot of changes.

    • Provides funds to support the costs related to the education of children in private psychiatric residential treatment facilities (F-6).
    • Provides funding for one year for group home residents who were determined to be ineligible for Medicaid personal care services on or after January 1, 2013. The maximum monthly payment is set at $464.30 and is based on providing 33 hours of service per eligible recipient (G-3).
    • Reduces General Fund appropriation for the Home and Community Care Block Grant (HCCBG) by 3%, leaving a balance of $31,808,889. Cuts are $969,549 (G-4).
    • Changes the income eligibility for the State-County Special Assistance (SA) Program from a method that bases income eligibility on the payment rate for the facility type where the recipient resides, to a method based on the federal poverty level for all recipients regardless of where they reside. The SA eligibility level is set at 100% of the Federal Poverty Level. Current recipients of SA are grandfathered in and will continue to receive SA. (G-8).
    • Provides funding to replace $4.5 million in federal block grant funds that counties lost in 2013-14 that was utilized to pay for Child Protective Services (CPS) workers. An additional $2.8 million in funding is provided effective October 1, 2014 to reduce county departments of social services caseloads to an average of 10 families per worker performing Child Protective Services assessments (G-9).
    • Provides $4.5 million for Child Welfare In-Home Services to serve at-risk families (G-9).
    • Provides $218,538 recurring and $125,750 nonrecurring funds for the implementation of drug screening for Work First Benefits applicants (G-10).
    • Provides funding through incentives and rebates to end the waiting list of the Aids Drug Assistance Program (G-11).
    • Provides $2.2 million for community-based crisis services (G-15).
    • Provider rates are cut, once again, by 1% (G-18).
    • Mental Health Drug Management: Authorizes DHHS to impose controls including prior authorization, utilization review criteria, and any other restrictions on mental health drugs (G-18 and pg 87 of the budget).
    • Provision to hold special session in November to discuss Medicaid Reform (pg 87, budget).

    Other Bills of Interest with Action:

    HB 884 Dropout Prevention/Recovery Pilot Charter School: This bill establishes a two year pilot program for one charter school who has had students drop out. The purpose is to increase graduation rates and reengage students. The bill passed the House and Senate and was presented to the Governor for signature.

    SJR 881 Adjournment: This bill directs legislators to adjourn but to return on August 14th and November 17th. As mentioned above, the November special legislative session will be focused on Medicaid Reform.

    HJR 1276 Adjournment: The House version of the adjournment resolution. While the dates to return are the same as the Senate, the House has a few more issues to keep alive including any bills related to autism insurance reform. The House gives the Senate until Wednesday, August 6th to take up the new adjournment resolution.

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    2014 NC Legislative Short Session Nears End But No Deal on Budget

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    Last week, the General Assembly saw more action from the Senate than the House, and Senators have been meeting in Rules Committee the past couple of weeks to pass a few pressing bills. On Thursday, while discussing Medicaid Reform on the Senate floor, Senator Bryant sought an amendment to expand Medicaid. Unfortunately, but not surprisingly, the amendment failed.

    Senators commented that this was the fourth time they voted down to expand Medicaid in the state. The House did meet on Thursday and Friday of last week, but they had little committee activity during the week. Despite filing an adjournment resolution for Friday, July 25th, the House does plan to meet this week. Rumors started over the weekend that legislators have reached another deal on the budget, so we hope to see the proposal this week.

    Relevant bills with action:

    short sessionHB 1181 Medicaid Modernization: This is the bill that would create a new department to oversee the operation of Medicaid and NC Health Choice run by a seven member appointed board, create full capitation by 2018 (instead of fee for service), integrate physical and behavioral health by 2016, and much more to reform Medicaid in our state. The bill went to committee to push back a few dates in the bill including the creation of the new department from August 1, 2014 to September 1, 2014. Senators will take a third, and final, vote on Monday night. The bill then has to get approval from the House before it is made law. No word yet on the House’s position on the bill.

    HB 369 Criminal Law Changes: This bill passed out of the Senate last week and is scheduled to be heard on the House floor on Tuesday. The bill will allow NASW-NC and other partners to work with the Human Trafficking Commission on age appropriate sexual abuse education for students and teachers. The bill also makes several changes to various criminal laws such as expungement for certain offenses and higher penalties for providing inmates with cell phones.

    HB 1133 Technical and Other Corrections: A bill that normally marks the end of the legislative session, the House and Senate have been working on a technical corrections bill to tie up loose ends of the session. Usually very technical in nature (spelling errors, corrections to previous bills, etc), the bill had a surprise section that would eliminate the Child Fatality Task Force that makes statewide recommendations to prevent unnecessary deaths of children.

    During the existence of the Task Force, childhood death has decreased by as much as 32% in the past three decades. During floor debate, Representative Grier Martin (D-Wake), ran an amendment to eliminate this section of the bill and it passed overwhelmingly. The bill passed out of committee and passed the floor Friday. The bill will now go to the Senate.

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