Daily News

Lexington Dispatch

By GARY D. ROBERTSON
Associated Press Writer

Lawmakers have shelved a proposal that would have removed thousands of people from government insurance rolls, but budget negotiators said Wednesday they still will control costs this year in the state’s Medicaid program.

"We wanted to do what we need to help to our less fortunate citizens," said Sen. Kay Hagan, D-Guilford, but "we need to look at what we can do to retain these costs."

The Senate budget contained a provision that would have saved $53 million this coming year by mov ing some patients from combined Medicaid and Medicare coverage to Medicare only.

The House spending blueprint didn’t include the plan, and Speaker Jim Black and Gov. Mike Easley vowed not to accept the reduction that would have cut coverage for 65,000 elderly, blind and disabled patients. State officials estimated 8,000 people would have lost their health coverage entirely had the Senate proposal become the law.

Health advocates have lobbied and negotiated with legislative leaders for several weeks to defeat the proposal. Senate leaders denied they wanted to hurt the poor with the provision, but said they needed to slow double-digit cost increases for the state’s Medicaid program.

Efforts to eliminate the dual coverage were prompted by the federal government’s decision to provide comprehensive drug coverage for Medicare patients beginning in January.

The estimated 8,000 patients who wouldn’t have qualified for Medicare would have had no health care coverage unless they first incurred thousand of dollars in medical expenses, according to the state Division of Medical Assistance, which oversees Medicaid.

"That’s what bothered a lot of us," said Rep. Edd Nye, D-Bladen, a budget negotiator. The Senate had set aside $5 million more to assist displaced patients.

Advocates for the poor and mentally ill were pleased to hear of the negotiators’ decision.

"A lot of folks today … are going to sleep a lot better tonight," said John Tote, director of the Mental Health Association of North Carolina. Tote estimated as many as 17,000 mental health patients would have been affected by the change.

Legislators in North Carolina and other states have had an incentive to reduce the number of people eligible for both programs because the federal government is demanding the states help pay for prescription drug coverage for these patients.

Those people would have eventually cost the state by ending up in public hospital emergency rooms or in the prison system, Tote said.

House and Senate negotiators were haggling Wednesday over spending for the Department of Health and Human Services, which oversees Medicaid. Negotiators are trying to complete the two-year spending plan before an Aug. 5 deadline.

Medicaid, the government’s health insurance program for 1.5 million low-income children, elderly and the disabled in North Carolina cost the state $2.3 billion last year.

Easley’s proposed budget sought a $215 million increase in Medicaid spending, even after suggested program cuts of $60 million. Both the House and Senate sought deeper cuts in Medicaid beyond what the governor offered.

Negotiators said the two chambers already have agreed tentatively to other cost-reducing moves.

Legislators plan to order Community Care of North Carolina, the managed-care program within Medicaid, to expand its coverage to include some people who would have qualified for Medicare and Medicaid. By putting more patients under stricter cost controls, legislators are looking to save $22.5 million compared to traditional Medicaid coverage.

The Division of Medical Assistance also will be ordered to save $6 million on personal care services.

Nye and Hagan also confirmed a new Medicaid spending forecast presented to legislative staff indicates that expenses will be $20 million less than previously projected.

Lawmakers must still decide whether to reduce Medicaid reimbursement rates for doctors, negotiators said. The doctor reimbursement rate of 95 percent is among the highest in the country. The Senate recommended a 90 percent rate.

Legislative leaders also are considering cutting reimbursements to pharmacists for the costs of drugs they dispense to Medicaid patients.

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This entry was posted on Thursday, July 28th, 2005 at 5:50 am and is filed under Daily News. You can follow any responses to this entry through the RSS 2.0 feed.