Differences in HHS proposals indicate that much work lies ahead for House and Senate negotiators
House budget subcommittee leaders released big pieces of their spending proposal Thursday, as the chamber began speeding toward passage of its full budget. Still to come are salary increases or bonuses the House will propose for teachers and state employees.
If it sticks to its schedule, the House will vote on its budget proposal by the end of next week and send it to the Senate. The Senate has passed its own spending plan, and the two versions are not the same. Traditionally, negotiators from the House and Senate resolve their differences and present a budget to the governor. But that can take a while.
The House and Senate budgets for health and human services have some striking differences.
The House proposal does not include expanding what’s called “pregnancy Medicaid” to 12 months from 60 days as the Senate budget does.
Doctors’ groups have pushed to allow women who qualify for Medicaid when they are pregnant to stay on the government insurance for a year after giving birth. They are usually cut off after two months. State professional societies representing OB/GYNs, pediatricians, and family physicians pushed for the extension. The American Rescue Plan gave states the option of adding the 10 extra months of Medicaid coverage for pregnant women. It would take effect in April and last for five years.
Adding the extra time has been a priority for maternal health advocates in North Carolina and around the country. The additional time is considered key to reducing maternal illness and death. Black and Native American women are 2 to 3 times more likely to die of pregnancy related causes than white women, according to the Centers for Disease Control and Prevention.
Both the House and Senate budgets include money to allow parents who use Medicaid to remain on the government insurance plan if they temporarily lose custody of their children. Senators who promoted the change said allowing parents to keep the insurance would allow them to enter court-ordered drug treatment. Parents who qualify for Medicaid have incomes far below the federal poverty line.
The House and Senate budgets do not include full Medicaid expansion, which Gov. Roy Cooper and Democrats in the legislature have long made a priority.
The House budget uses $13 million from the state legal settlement with Juul for programs aimed to get young people to quit using e-cigarettes and other tobacco products. Attorney General Josh Stein settled a lawsuit with the e-cigarette company, which agreed to pay the state $40 million over six years. The $13 million is the first installment. Stein sued the company claiming it had designed products and marketing to attract middle- and high school students.
Money from the American Rescue Plan, which provides states with pandemic relief funds, is giving a significant boost to spending on early childhood education, independent living for people with disabilities, and direct care worker salaries.
As Policy Watch previously reported, North Carolina is receiving $1.3 billion from the American Rescue Plan for early childhood education and to support childcare centers. The money is coming in several streams. Here’s how the House budget proposes to spend $502.8 million from the Child Care and Development block grant.
- Up to $215 million would be used to reduce the waitlist of children eligible for subsidized care, starting with foster children.
- Up to $30 million would be used to cover co-pays for children in subsidized care through the end of this year.
- Up to $207.8 million would be used to build the pipeline of childcare teachers through the use of bonuses, apprenticeships, and fast-track programs. Bonuses would be based on how long a teacher or staff person has worked at a childcare facility.
The House budget creates a new $274.8 million Home and Community Based Services fund with the help of the federal relief money. The budget transfers state taxpayer money into the fund and replaces it with federal money.
Money from this fund would be used to add 1,000 people with disabilities to a program that allows them to live outside institutions or group homes, increase wages for direct care workers, and extend home health services to people on Medicaid who are moving out of institutions.
The House budget gives $10.6 million for medication assisted treatment programs run by the state Department of Public Safety. The program is for people with opioid addictions who are being released from minimum security prisons.
As Policy Watch reported in April, a study found that the risk of heroin overdose death among people newly released from prison was 74 times higher than for the general population.
The money would expand the program to nine more prisons and make medication assisted treatment available to people on probation in five more counties.
The House included the substance of House Bill 608 in its budget as a “special provision,” which would limit shackling of incarcerated women while they are pregnant, while in labor, and for six weeks after giving birth.
The bipartisan bill passed the House unanimously in May, but not has not been heard in the Senate. Counties currently handle incarcerated women in childbirth differently.
The measure would allow newborns to stay with incarcerated mothers while they are in the hospital. The state Department of Public Safety would put a priority on placing mothers in prisons that are within 250 miles of their children younger than a year old. Infants would be allowed to visit their incarcerated mothers at least twice a week.
The bill has the support from a broad spectrum of groups including the ACLU of North Carolina and the NC Sheriffs’ Association.