Budget Summary

Summary of 2012 Budget

The NC House and Senate came to an agreement this week on the 2012 budget. The total budget spends 2.5% more than the budget as approved last year.  Unfortunately, the budget does not include compensation for victims of North Carolina’s sterilization program.  The Governor now has 10 days to veto the budget.  The budget was approved by a veto-proof majority in both chambers so any veto would likely be overridden.  The legislature plans to adjourn as soon as possible after a veto override, which would be Monday, July 2d at the latest.

Below is a brief summary of the budget items related to the work of Disability Rights NC.  The full budget is online here.  The money report is online here.

Education Budget

·      LEA Adjustment Reduction - $143 mil to reduce cuts to LEAs, still leaves huge shortfall from expiring federal funds used to curb previous cuts

·      Residential Schools - None will be closed.  Restores $4.7 mil of cuts. Section 7.3 discusses School Improvement Plans, Section 7.8 repeals consolidation.

·      Section 7A Excellent Public Schools Act: $27 mil: developmental screening and Kindergarten entry assesement; elimination of social promotion; reading development for retained students; school performance grades; establishes NC Teacher Corps; allows for local plans for performance pay.

Health and Human Services Budget

Division of Medical Assistance

• $59 mil in CCNC savings
• Reduced savings expected from 1915 b/c waiver transition by $1.7 mil, due to delays
• $3.8 mil savings from fraud, waste and abuse prevention
• Restructure Fee for Service for $2 mil savings
• $14 mil CHIPRA bonus
• $15 mil for cost settlements with providers and fraud, waste and abuse initiatives
• $6 mil reduction associated with changes to PCS program
• Section 6.12 – Requires Medicaid disclosures to fiscal research (Senate budget item)
• Management flexibility reductions across departments to achieve savings for Medicaid program (Section 6.14): In order to provide adequate funds to cover any potential shortfall in the 2012-2013 Medicaid budget while minimizing the impact on State government services, the Director of the Budget shall ensure that cost savings required through the management flexibility reductions in this act are realized so that at least fifty percent (50%) of the cost savings are realized by December 31, 2012.
• Limits on ST/OT/PT repealed.
• COLA disregard (Section 10.6):  Income disregard for Medicaid effective January 1, 2013.  Sunset of December 31, 2017.
• Medicaid Non-Emergency Medical Transportation - develop an RFP for management.  House had $1 mil in associated savings, that amount is not in final budget.
• Pharmacy services (Section 10.8): keeps $24 mil in projected savings from increased use of generics.  Adds expanded prior authorization to save $5.3 mil; special pharmacy program for hemophilia drugs.
• Section 10.8A - Study electronic prior authorizations for prescriptions
• Section 10.9 Smart Card Pilot Program - $1 mil to implement
• Section 10.9A State Auditor Audit of DMA: The audit shall examine the program's effectiveness; results of the program; the utilization of outside vendor contracts, including the number, cost, and duration of such contracts; fiscal controls and Medicaid forecasting; and compliance with requirements of the Centers for Medicare and Medicaid Services and the requirements of State law.
• Section 10.9B PED/FRD Study of Medicaid Organization: The Program Evaluation Division and the Fiscal Research Division of the General Assembly shall jointly study the feasibility of creating a separate Department of Medicaid and make a joint recommendation on this issue to the 2013 Regular Session of the General Assembly no later than February 15, 2013.
• Section 10.9C: No authority to reduce provider rates or services:  DHHS shall not reduce Medicaid provider payment rates or Medicaid optional services except as otherwise provided to achieve Medicaid pharmacy program savings.
• 10.9E Special Care and Memory Care Units: DMA shall develop and submit to CMS an application for a home- and community-based services program under 1915(i) for elderly individuals who (i) are typically served in special care  and memory care units that meet the criteria of the State-County Special Assistance Program  and (ii) have been diagnosed with a progressive, degenerative, irreversible disease that attacks  the brain and results in impaired memory, thinking, and behavior. The home- and  community-based services program developed by the Department pursuant to this section shall  focus on providing these elderly individuals with personal care services necessary to ameliorate  the effects of gradual memory loss, impaired judgment, disorientation, personality change,  difficulty in learning, and loss of language skills.
• PCS 10.9 F added limited assistance with 3 ADLs: Directs implementation of PCS  for recipients who have a medical condition, disability, or cognitive impairment and demonstrates unmet needs for, at a minimum, (i) three of the five qualifying activities of daily living (ADLs) with limited hands-on assistance; (ii) two ADLs, one of which requires extensive assistance; or (iii) two ADLs, one of which requires assistance at the full dependence level.   The five qualifying ADLs are eating, dressing, bathing, toileting, and mobility.  The recipient resides either in a private living arrangement, a residential facility licensed by the State of North Carolina as an adult care home, or a combination home as defined in G.S. 131E-101(1a).
• Appropriations Contingent upon adequacy of funding for Medicaid budget (Section 10.9G): DHHS shall not expend funds appropriated for the following purposes until January 1, 2013, pending a determination by the Office of State Budget and Management that there is adequate funding for the Medicaid budget for the 2012-2013 fiscal year: (1) Funds appropriated to DCDEE for NCPC; (2) DMH/DD/SAS funds for additional psychiatric care beds at Broughton Hospital and additional local inpatient psychiatric beds or bed days available to LMEs and MCOs under the State-administered three-way contracts ($9 mil additional); and (3) funds appropriated to DPH for local community health and wellness initiatives.
• Examination of the state's delivery of MH Services (Section 10.11): Directs the HHS Oversight committee to appoint a subcommittee to examine the State's delivery of mental health  services. As part of its examination, the subcommittee shall review all of the following:  (1)  The process for determining the catchment areas served by the State's psychiatric hospitals, with consideration of both of the following:   (a) Factors used in assigning the geographic groupings of local management areas and managed care organizations into catchment areas. (b) Alternatives to the current process for determining the catchment areas served by the State's psychiatric hospitals, including a determination of whether there is a more efficient and equitable manner of assigning hospital catchment areas. The subcommittee shall report its findings and recommendations to the Joint Legislative Oversight Committee on Health and Human Services  on or before January 15, 2013, at which time it shall terminate.
• AIDS Drug Assistance Program Pilot (Section 10.16)
• $5 mil reduction to nonprofits (Section 10.18), minimizing reductions to funds allocated to nonprofit  organizations for the provision of direct services and shall not reduce funds allocated to  nonprofit organizations to pay for direct services to individuals with developmental disabilities.
• SA In-home (Section 10.23) - keeps 15% cap (although can be waived by the Secretary) but equalizes the amount, all counties shall participate, a formula will be established

DCDEE

·      PreK - $15 mil increase in House - NO increase in final budget.  Directs DCDEE to continue implementation of the NC Pre-K program.  Includes chronic health and developmental disabilities as factors for eligibility requirements along with 75% of the state median income

• $3.5 mil to NCPC for early literacy and TA re grant and fundraising - after January 1 only if not needed for Medicaid

Div of Central Management

·      $2.7 mil reduction for administrative efficiencies

·      Non-state entity pass-through funds - makes NR and 10% match to entities like Arc, Autism Society, Easter Seals

Div of Aging and Adult Services

·      Transition to Community Living $10.3 mil (10.23A) - Blue Ribbon commission, DOJ same

·      Short Term Assistance $39.7 mil monthly rate for residents while they "transition," Sets out amount per resident that may be paid, steps it down after 3 months, expires June 30, 2013.

DMH

• No restoration of MH community service funds - $20 mil cut
• 3 way contracts - $9 mil increase Jan 1, 2013 contingent upon Medicaid, was increase of $18.5 mil in House budget
• LME Admin Funds reduced by $8.5 mil
• Cherry Hospital - funding for increased bed capacity (124 beds) at the new Cherry hospital $3.5 mil
• Broughton Hospital - 19 addnl psych beds $3.5 mil after Jan 1, 2013 if money not needed for Medicaid
• Drug Treatment Courts - $2.3 mil eliminated

Div of Public Health

·      Medication Assistance Program - $1.7 mil NR in House budget

·      $4.9 mil to county health departments for community health and wellness initiatives, contingent upon Medicaid

Justice and Public Safety

·      DPS Management Flexibility Reductions – $26.3 mil – In implementing, the department shall NOT close the Bladen Correctional Center, reduce community program funding in either the Div of Adult Correction or Juvenile Justice, or eliminate any district level state highway trooper position

Corrections

·      Revised the Inmate Medical Costs special provision

Juvenile Justice

·      Close Edgecombe YDC Jan 1, 2013.  Transfer 10 youth counselor associate positions, 5 to Chatham and 5 to Lenoir to increase their bed capacity.  Also directs a study  of the use of the facility.

·      Multipurpose Group Home Funds (Section 14.6) - $550,000 for a multipurpose group home in Craven county

Justice

·      $1.8 mil reduction to eliminate state funding to Consumer Protection division

·      IDS - no changes

·      AGs must begin doing itemized bills for their work for agencies, must also do biannual reports

General Assembly

·      Program Evaluation Division shall study the duties and services of the NC Human Relations Commission and the Civil Rights Division of OAH to determine whether there is unnecessary overlap and duplication of services and recommend the placement of the Commission and Division in the appropriate agency or agencies.

State Board of Elections

·      HAVA Funds/Disability Access:  Directs the State Board of Elections to retain HAVA Title II funds until MOE funds are appropriated, EXCEPT for voting accessibility funds under Section 261 of HAVA.

Salaries and Benefits

·      State employee and public school employee 1.2% salary increases

Office of the Governor – Housing Finance Agency

·      Housing Trust Fund - eliminates General Fund appropriation and appropriates $7.9 mil from Mortgage Settlement Agreement