Where Does the Money Go? NC State Budget and Bill Tracking Update

State Budget Update

North Carolina is required to balance its budget each year, and health and human services makes up 22.4% of the already tight $24 billion budget

In North Carolina and across BAYADA’s GAO states, our legislative goals tend to revolve around two main tenets: First, achieving policies that streamline processes so that service offices can operate without added burdens and so residents can readily access care, and second, to increase reimbursement rates so that we can recruit and retain the caregivers necessary and ensure that we have the supply necessary to meet the demand.  

It seems like common sense—North Carolinians want to stay in their homes, and home care services cost states less than care delivery in a different setting. So why can’t legislators simply fund home care programs at higher rates? The truth is that there are many competing interests and priorities, and limited amounts of state resources.

It is important to recognize the constraints with which lawmakers must work. Last year, Health & Human Services represented 22.4% of North Carolina’s nearly $24 billion state budget, second only to education, which represented 57.5%. Looking forward to the upcoming budget year, the state’s fiscal research arm reported that top budget pressures include: public schools, higher education, the state health plan, and Medicaid/Health Choice—meaning that there is a lot of pressure on the state’s already tight budget—and that’s not to mention the other interest groups we compete with, such as state nursing homes and other healthcare coalitions.

As GAO continues to garner legislative support for $29.5 million in state funds needed for the Medicaid rate increases we are seeking, advocacy efforts will play an important role. Please watch for ways to support our legislative ask, and please reach out to Mike Sokoloski at msokoloski@bayada.com to learn how you can get involved in advocacy on behalf of your staff and clients.

NC Bills we are following


“I’m just a bill” – Knowing the path by which a bill must travel is important as we follow various bills. 

To date, 824 bills have been filed in the North Carolina General Assembly this session. GAO continues to work through the proposed bills to evaluate their impact on home health care, home care, and hospice. Below are a few bills that are of interest:

1. H70 – Delay NC HealthConnex for Certain Providers, sponsored by Representatives Dobson, Murphy, White, and Lambeth

Home care champion Representative Josh Dobson submitted the bill that extends the deadline by which certain providers, including home care and home health care agencies, must participate in and submit data to the state’s Health Information Exchange Network, NC HealthConnex.  We commend the bill sponsors for this delay.

While participation in and submission to NC HealthConnex is important and necessary in that it grants both the state and providers electronic, timely access to demographic and clinical data, our industry and others provider sectors do not have a consistent platform or an easy way to gather and transmit the required data. Access to this data and clinical information will help the state and providers identify spending trends that will facilitate health care cost containment while also improving health care outcomes only if the data is reliable and consistently reported.

This extended deadline proposed by House Bill 70 grants us additional time to meet the reporting requirements.  We thank all the bill signatories for recognizing the administrative burden and granting additional time to meet the requirement.

The bill passed both the House floor on March 27, 2019 and is headed to the Senate.

2. H745– Medicaid Funding Request for Private Duty Nursing (PDN), sponsored by Representatives White, Lambeth, Adcock, and Cunningham

Our health care members, a home care nurse (White), a hospital administrator (Lambeth), a nurse practitioner (Adcock), and a hospice nurse (Cunningham), introduced H745 to increase the Medicaid funding for nursing under PDN from $39.60 to $45.00 by requesting $4.1M for 2019-2020 and $8.3M for 2020-2021 in recurring state funds.

As health care leaders, they recognize the importance our services play in keeping some of North Carolina’s most clinically complex citizen at home and out of more expensive settings. While the necessary funds were not allocated in the House Budget, we have an opportunity to get it into the Senate Budget and are continuing to advocate for this option.   

3. H728– Increase Innovation Waiver Slots, sponsored by Representatives Insko, Hawkins, and Lambeth

This bill appropriates 500 Innovation Waiver Slots to address the waiting lists. It would support North Carolinians living with intellectual and developmental disabilities (I/DD) and help them receive needed services within their home and community.  The bill proposes to appropriate $5.3M for 2019-2020 and $10,9M for 2020-2021 in recurring funds.

4. S361– Increase Innovation Waiver Slots, sponsored by Representatives Insko, Hawkins, and Lambeth

This proposed bill attempts to address several different health care issues in one bill. This approach makes it challenging to garner support in its entirety.  The bill includes the following provisions:

  • Elimination of Certificate of Need (CON) – Any action that erodes the established process by which a need is determined may lead to destabilizing our health care industry. The established CON process allows for any group to apply for a Special Needs Determination should they feel health care needs are not being met in their community.
  • Establishes a carve-out for PACE organization – Any action that allows a group to be exempt from following Home Care Licensure Rules puts recipients at risk as the organization would not be required to follow health and safety rules outlined state licensure.
  • Medicaid Expansion – Any opportunity for the North Carolina’s working poor to have access to health care coverage, the better. This provision includes a work requirement with exceptions for individuals attending school and or deemed disabled.
  • Addition of Innovation Waiver Slots – Any opportunity for more individuals living with intellectual and development disabilities (I/DD) to have access to needed services, the better.

The introduction of this bill is the first step in a long process. GAO will continue to monitor and support the I/DD slot provision which aligns with our access to care goals. Some of the other items are very controversial because they create a slippery slope on oversight.

To find out what you can do to encourage your legislators to support the introduction of this bill, contact Lee Dobson at ldobson@bayada.com.

PA Budget Record: First Early Budget in Over Four Years!

 

 

 

 

 

 

 

For the first time in over four years, the Pennsylvania General Assembly completed the FY 2018-2019 budget ahead of the constitutionally mandated June 30 deadline.

During our Advocacy Day in Harrisburg, House Appropriations Chairman Stan Saylor announced he was working to get us an increase in personal assistant services (PAS) provided under the Office of Long-Term Living. This was Pennsylvania’s primary legislative priority for BAYADA in 2018.

After this announcement the Government Affairs Office (GAO), home care advocates, and the Pennsylvania Homecare Association (PHA) worked at breakneck speeds to make it a reality. In the month leading up to the final budget we met with Chairman Saylor and staff several times, spoke with key leadership, and touched the entire legislature several times. Unfortunately, the legislature passed, and the Governor signed, the FY 2018-2019 budget without this increase.

We have been working towards this increase since 2014 and we have made incredible progress. We will continue to ensure this remains top of legislators’ minds. This summer we will begin our work to ensure we receive a rate increase in next year’s budget.

Thank you for your support, and for the time that you took participating in our efforts, whether it was by emailing legislators through our action alert, which generated over 430 emails to legislators, or through your attendance at PHA’s Advocacy Day in Harrisburg. All of these efforts showed legislators just how widespread and important this issue is, and we have heard directly from many who told us how impactful our efforts continue to be.

Approved State Budget Includes Reimbursement Rate Requirement

The New Jersey state legislature avoided a government shutdown when Governor Murphy signed the proposed budget into law late Sunday, July 1. The approved budget sets the state fee-for-service rate at $19.00 per hour and establishes a rate floor, which requires MCOs to reimburse home health care providers at no less than $16.00 an hour for personal care services.

GAO is continuing to work closely with legislators to further clarify the Personal Care Assistant (PCA) increase, which passed last year (A320). This clarification will address the direct and indirect costs that were overlooked by Governor Christie’s conditional veto last session. For more information, don’t hesitate to reach out to advocacy@bayada.com.

NJ Managed Medicaid Bill Receives a Conditional Veto

Submitted by Louise Lindenmeier, Director, NJ Government Affairs (GAO)

Governor Chris Christie conditionally vetoed A320/S1018, which sets a minimum managed care reimbursement rate for the Personal Care Assistant program at the state’s fee for service rate.  His veto addresses a wage pass through, budget funding for fiscal year 2019, removal of the Consumer Price Indices adjustment every 5 years and included an audit process for the increase in reimbursement.   On July 31, the bill went back to the Assembly where it received unanimous support by the legislature.  The Senate will vote on the bill when they reconvene for it to become law. The Government Affairs Office (GAO) will work with the industry on how to address the new stipulations within the bill.

Capital Day in Trenton, NJ

Submitted by Louise Lindenmeier, Director, NJ Government Affairs (GAO)

On June 15, 25 Hearts for Home Care Ambassadors met in Trenton for a Town Hall meeting hosted by our lobby group, Capital Impact Group. Chief Government Affairs Officer David Totaro and lobbyists Gene Mulroy and Paul Crupi discussed the upcoming election, budget, and what we will see in the next administration. Dave addressed what is happening in Washington with health care changes and possible impacts on our state. After a quick lunch, the group toured the State House, where they were able to meet legislators in the halls and gain an overview of the State House history. Everyone enjoyed the day.

Personal Care Assistant Fee-for-Service Rate Increased in NJ State Budget

Submitted by Louise Lindenmeier, Director, NJ Government Affairs (GAO)

On July 3, Governor Christie signed the NJ budget which contains a budget resolution to increase the Personal Care Assistant rate under fee-for-service. I am happy to inform you the NJ PCA fee-for-service rate is now $19.00 per hour. The new rate is effective as of July 1, 2017.
This is largely due to the support of BAYADA leadership, the directors and their office staff, and our wonderful Hearts for Home Care Ambassadors who made legislative office visits, held legislative roundtables, and offered home visits advocating for our clients and families. Great advocacy efforts by all!

NC Long Legislative Session Gaveled Out

Submitted by Lee Dobson, Area Director, NC Government Affairs (GAO)

Last week Speaker Tim Moore and President Pro Tempore Phil Berger ended the long legislative session after passing, along party lines, North Carolina’s 23 billion dollar budget. The budget contained a few provisions we asked for, but not everything. The budget was sent to Governor Roy Cooper for signature. As expected, the budget was vetoed and must be sent back to the General Assembly. Lawmakers plan to return in August where the Republican-majority has sufficient votes to override the veto. It is reported the General Assembly will reconvene for as many as three Special Sessions this year – on August 3rd to address any bills vetoed by Governor Cooper, and on September 6th and November 15th to address redistricting, as the US Supreme Court ruled that our current NC House and Senate maps unconstitutionally disenfranchised African American voters.

While members are back in their districts our Hearts for Home Care Ambassadors will be reaching out to schedule home visits and hosts legislative round table with their offices.   Watch for ways to get involved.

North Carolina Budget Released

Submitted by Lee Dobson, Area Director, NC Government Affairs (GAO)

On June 19, lawmakers released a $23 billion budget for 2017-2019. Below are some of the provisions impacting us:

  • Increased Personal Care Services Rate: This provision increases the Medicaid rate for aide services under the Personal Care Services (PCS) program and the Community Alternatives Program for Children (CAP-C). The rate will increase from $13.88 to $15.50 (July 1, 2017) and $15.60 (January 1, 2018) pending approval from the Centers for Medicare & Medicaid Services (CMS). Much to our disappointment, CAP-DA was left out of the budget. A technical issue made it difficult to increase the CAP-DA rate within the established budget neutrality requirement. A rate increase would have meant fewer authorized hours for clients to stay within overall program requirements. BAYADA’s Government Affairs Office continues to work on a solution.
  • Protected the certificate of need (CON) for home health care from being eliminated.
  • Expanded Innovations Waiver slots: This provision added 400 additional Innovations Waiver slots across the state.

Delaware Joint Finance Committee Begins Budget Debate

Submitted by Shannon Gahs, Associate Director, DE Government Affairs (GAO)

After months of hearing from state departments and constituents about the issues that matter to them, the 12-member Joint Finance Committee begins debate, called “markup,” over the state budget.  Governor John Carney’s proposed budget announced earlier this year balanced on a $200M increase in tax revenue and $200M in cuts to state programs.  The legislature is discussing a plan that would increase taxes by $100M, requiring more cuts to balance.

MassHealth Announces Second Rate Increase In The Face Of Budget Deficit

Submitted by Laura Ness, Director, Government Affairs (GAO)

Last week, Chief Government Affairs Officer Dave Totaro, Boston Pediatrics Director Emery Hughes, and other industry leaders and families gathered together to meet with MassHealth.  MassHealth had asked for the meeting, in regards to the Continuous Skilled Nursing (CSN) program.  During the meeting, MassHealth stated that they recognized that low reimbursement rates were a major problem within the program.  They have planned to increase the rates by 2.25% effective July 1, 2017.  This is the second reimbursement increase we have been notified about within three months.  The organizations working to increase this rate were pleased with this movement but recognized that this is a fraction of what is needed to stabilize the rates.  We look forward to continuing our efforts to increase the CSN rates by a total of $15 per hour.