Cooper's Health Budget Helps North Carolina's Most Vulnerable People

Written by Rose Hoban

Gov. Roy Cooper will focus health care on North Carolina's most vulnerable youth, North Carolina's most vulnerable youth, and his government in his proposed state spending plan after he removed Medicaid expansion from the governor's to-do list. Moved to the needs of the elderly and people with disabilities. Next year.

One of the most important items in his $34.5 billion recommendation to lawmakers comes as federal pandemic funds used to help keep centers and preschools open are depleted in the coming months. , $630 million in subsidies for child care.

The governor also proposes setting aside more funding for people with disabilities to strengthen the Medicaid program to provide more home care options for people with disabilities. This allows them to work and participate in community life without relying on institutional care.

Cooper also recommended that $445 million be used to increase wages for direct support caregivers who work with people with disabilities and increase Medicaid reimbursement rates for health care providers. There is.

Cooper criticized Republican-led General Assembly leaders for spending too much taxpayer money on scholarships and vouchers for K-12 students to attend private schools. He was also critical of the approval of corporate and personal tax cuts planned to take effect over the next few years.

In particular, Mr. Cooper took aim at corporate taxes, which are scheduled to be eliminated by 2028 and which the nonpartisan Legislative Fiscal Research Service says will leave a multibillion-dollar hole in the state's budget.

“CEOs aren't asking us about income tax or corporate tax cuts,” Cooper said. “They ask us about getting quality educated people to work for them. They ask us about early childhood education, childcare. They ask us about career training, They're asking about schools, community colleges. They're worried about employees with young children having to quit their jobs because they don't have child care.”

Even with billions of dollars in surplus in the state's treasury, Mr. Cooper will likely face headwinds on spending proposals from the state's non-veto-proof Republican majorities in the House and Senate.

Avoiding the parenting “cliff”

Cooper said more needs to be done for child care, as the state Chamber of Commerce, a powerful business lobby, has been sounding the alarm over the past year about an impending crisis that would begin with additional federal pandemic funding. There is a possibility that Republicans will agree on the issue of sexuality. He no longer feeds the state coffers.

Many child care centers received aid that was supposed to expire last fall, but an extension from Congress means the funding will last until the end of June.

Without support from federal or state funds, about 1,800 centers across North Carolina are expected to close this summer, just as the pre-K population is expected to surge.

“From zero to four [year-olds] We're looking at 7% growth over the next few years,” said Kristin Walker, director of budget at Cooper.

Last year, the Chamber of Commerce sponsored a survey of workers and child care providers that found that the lack of reliable child care “takes a toll on families and makes it difficult for businesses to hire workers and grow. “It has been found.

The survey found that three-quarters of voters think the lack of childcare is a “serious problem” and support increasing state funding to address the problem.

Cooper's budget provides $200 million in one-time stabilization grants to help centers improve employee pay with benefits.

In addition, Cooper's budget sets aside an additional $165 million in recurrent funding to cover the full cost of waitlist slots in the state's public school preschool programs, as well as funding for early childhood child care services. $128 million in recurrent funds has been set aside to increase fees paid as subsidies. A household with an income.

The governor's budget also includes $24 million for a pilot matching funds program to help businesses contribute up to $2,500 to employee flexible spending accounts to offset child care costs.

“We know these grants work,” Cooper said. “Funding will also be prioritized to help parents afford child care, support qualified educators to continue their education, and make child care more accessible, especially in rural areas.”

Senate Majority Leader Phil Berger (R-Eden) said there were “some things in Cooper's budget that we can work together on” and suggested there could be improvements to the child care budget.

Support for people with disabilities

In North Carolina, there are 16,000 people with disabilities on the waiting list for the Innovation Waiver Program. This program enables people with intellectual and developmental disabilities to live at home with comprehensive support to find work, stay in school, and participate in the community. was established in life.

The program was underfunded and failed to deliver on its promises, prompting the North Carolina Office of Disability Rights to file a lawsuit in state court, demanding that the state commit to doing more.

Support for people with intellectual and developmental disabilities can be expensive, with the highest-cost beneficiaries requiring more than $100,000 in annual support.

Not all participants require that level of spending. Mr. Cooper set aside $17.5 million in his proposed spending plan to fund 1,000 additional slots in the Innovation Waiver Program. This works out to an average of $17,525 per additional program participant.

A big-ticket item that helps people with intellectual and developmental disabilities get the care they need is raising wages for caregivers. There is an increasing shortage of direct support professionals to care for elderly residents as well as people with disabilities. Cooper's budget would increase wages for those workers by $4 an hour, up from $14 an hour, to a maximum of $18, costing them an additional $180 million next year and each year thereafter. .

His budget also calls for $265 million a year to increase fees for doctors, dentists and specialists who treat Medicaid patients. It is not specified how much each job will cost.

Dentists have been lobbying for higher Medicaid reimbursement rates since December's Medicaid expansion added an additional 600,000 people to oral health care. The current redemption rate (about 34 cents on the dollar) is the same as it was in 2008. As a result, many dentists do not accept Medicaid patients.

The governor also set aside $9.4 million to increase funding for the Transition to Community Living Initiative, which will move approximately 3,500 people with mental health and developmental disabilities from institutional living settings to supportive services. The aim is to transition to local communities with The spending was mandated by a 2012 settlement with the U.S. Department of Justice after North Carolina was found to have violated the Americans with Disabilities Act, which requires states to provide community assistance. is required to provide.

Responding to the needs of an aging society

Cooper noted that North Carolina's aging population is growing, especially in rural areas. By the end of this two-year budget, North Carolina will be home to approximately 2.1 million seniors, but state spending to support them has not kept pace with demand.

“As the baby boomer generation ages, there will come a time when one in five North Carolinians will be over the age of 65,” Walker, Cooper's budget director, told reporters. “Of course, that impacts the demographics of the state, the services needed and the services provided.”

Last year, the governor announced a government-wide effort to make the state a better place to age. To facilitate just a portion of that, Cooper's budget would include a one-time infusion of $10.5 million in leftover federal dollars from the American Rescue Plan Act to be used to renovate and upgrade about 1,500 rural homes. I'm looking for. Preventing the elderly from moving into institutions.

One DHHS office struggling with staffing was the division responsible for inspecting health care facilities, which was too understaffed to effectively enforce nursing home rules. The office will receive $2.8 million annually and a total of 20 new employees, including three additional inspectors to oversee assisted living centers and nursing homes.

Cooper's proposed spending plan also includes:

• A flat 5% pay increase for all state employees is at the top of the state Department of Health and Human Services' wish list. Kody Kinsley is struggling to find work at a state-funded facility that cares for mentally ill patients.
• $109 million for temporary cost-of-living increases for retired state employees. Because DHHS is one of the largest state agencies, this will impact tens of thousands of former agency employees.
• Nearly $8 million in recurring funds for the Office of the Chief Medical Examiner to purchase toxicologists, pathologists, and equipment. The OCME office's workload has increased over the past decade as the opioid overdose epidemic hit the state.
• $4.5 million in annual funding will be provided to support the capacity of the state's Office of Vital Records. The governor's budget document states that the vacancy rate for the vital records office is 45 percent.

The state budget process will unfold over the coming weeks and likely months as members of both chambers develop their own spending plans. The new fiscal year begins on July 1st.

Since this is an election year, lawmakers running for re-election may strive to meet that deadline, unlike last year, when the budget was not approved until the end of September.