A legislative oversight committee heard the latest update about the Medicaid budget this week and the news was mixed. The state program is facing a shortfall of $130 million this year, smaller than last year’s hole, but still a significant amount of money.
Part of the problem is that officials with Department of Health and Human Services have been unable to find the savings that were built into the Medicaid budget passed last year partially because of mistakes made by the department that one lawmaker called sophomoric.
HHS officials also neglected for months to inform state lawmakers about their struggles to save money, which prompted more criticism from budget writers.
Lawmakers were also told that part of the shortfall comes from the roughly 81,000 new people eligible for Medicaid this year, many of them signing up through the enrollment process under the Affordable Care Act.
That prompted another round of complaints about the ACA and Medicaid from inside and outside the legislative building from folks looking for any opportunity to bash the health care law and people trying to blame Medicaid costs for the struggle to give teachers a raise.
That doesn’t make any sense since lawmakers and Governor McCrory chose in last year’s budget to pay for big tax cuts for corporations and wealthy individuals instead of giving teachers a long overdue pay hike and like to use Medicaid to change the subject.
But there’s something else about this week’s update on the Medicaid budget that’s even more troubling, the implication that 81,000 people who are eligible for Medicaid signing up for the program is a problem.
This has nothing to do with Medicaid expansion under the Affordable Care Act. Governor McCrory and state lawmakers chose not to expand the program to cover 500,000 low income adults. These are people who qualify for Medicaid under the old existing criteria but had never enrolled.
The vast majority of them are seniors, children, pregnant women, and people with disabilities who meet the income guidelines set by state lawmakers. These are the most vulnerable people in North Carolina who have been struggling to get basic health care even though they qualify for it under a state and federal program created to provide it.
The enrollment process of the Affordable Care Act helped these people realize they are eligible for Medicaid and they are signing up for the care that the law and common decency says they deserve to get.
They may increase the overcall cost of Medicaid in North Carolina next year, but they are not a problem. The fact that they are enrolling is good news. It may actually save health care costs in the long run if they can now see a doctor instead heading to the emergency room for treatment.
And it will surely improve their lives if they can seek care when they need it and not have to choose between paying a doctor or paying the rent.
State lawmakers understandably need to hear about Medicaid budget projections to help them put a spending plan together for next year. And they need to stay on top of HHS officials to make sure they are doing all they can to find savings and run the program efficiently.
But they also need to stop thinking of every increase in Medicaid spending as a problem. It is good news that more people who are eligible for Medicaid are now signing up for coverage. That is the point of the program after all, to provide health care for the most vulnerable people in North Carolina.