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2 <br /> 1 • provide assistance to NC residents, especially youth, who are dealing with the <br /> 2 impacts of COVID; <br /> 3 • Increase innovation waiver slots more aggressively to meet the Olmstead Act <br /> 4 requirements; and <br /> 5 • Increase compensation for nurses and direct support staff funded by innovation <br /> 6 waivers and other Medicaid sources. <br /> 7 <br /> 8 She said Alliance Health has been Orange County's Managed Care Organization (MCO) <br /> 9 for one year. She said they are all aware that there is a shortage of funding for mental and <br /> 10 behavioral health services. She noted there are 16,000 people on the waitlist for Innovations <br /> 11 Waivers, which are for people with intellectual/developmental disabilities (I/DD) who could live in <br /> 12 the community rather than an institution. <br /> 13 <br /> 14 Chair Bedford reviewed the second list on the Board's list of priority legislative issues: <br /> 15 <br /> 16 Medicaid Expansion — Support legislation increasing access to the Medicaid program <br /> 17 to make health insurance available to North Carolina residents at 138% of the poverty <br /> 18 level; broaden the opportunity for coverage for more than 500,000 North Carolinians to <br /> 19 address chronic conditions and to prevent illness and disease progression; to provide <br /> 20 additional support for rural hospitals; and to protect families from medical debt and <br /> 21 bankruptcy. <br /> 22 <br /> 23 She said the North Carolina House of Representatives passed legislation expanding <br /> 24 Medicaid, and asked Senator Meyer what the next steps are. <br /> 25 Senator Meyer said there's broad agreement that Medicaid expansion will happen. He <br /> 26 said there are only questions about the timeline and what other legislation will be tied to it. He <br /> 27 said if it's passed by the end of March 2023, North Carolina would receive $1.4 billion in federal <br /> 28 bonus. He said there is discussion about tying expansion to Certificate of Need reform and <br /> 29 expansion of advanced practice for nursing. <br /> 30 Chair Bedford asked Senator Meyer to explain both of those issues. <br /> 31 Senator Meyer said Certificate of Need is a law in North Carolina that governs <br /> 32 healthcare facility expenses. He said it requires state approval before the purchasing any major <br /> 33 healthcare facility cost that justifies there is a need for it. He said it's an attempt to regulate both <br /> 34 healthcare costs and the distribution of healthcare facilities across the state, including rural <br /> 35 hospitals. He said the downside is that it may prevent market-based competition so costs are <br /> 36 higher if there's limited availability. He said there is probably some middle ground, but the <br /> 37 negotiations on that issue in the North Carolina Senate are more complex than just Medicaid <br /> 38 expansion. <br /> 39 Senator Meyer said the issue of advanced practice nursing looks at whether nurses <br /> 40 should be able to practice independently without the supervision of a doctor, which could bring <br /> 41 down costs and expand access to healthcare, but some argue is more risky. <br /> 42 Commissioner Greene asked for Senator Meyer to outline what each party wants related <br /> 43 to Certificate of Need. <br /> 44 Senator Meyer said the issue isn't partisan, but is more about what independent doctor <br /> 45 practices want vs. what hospitals want. He said Medicaid expansion would change the <br /> 46 economics related to profits at both types of healthcare facilities, which is why the North <br /> 47 Carolina Senate wants to address both issues at the same time. <br /> 48 Commissioner Richards asked how common Certificate of Need and advanced practice <br /> 49 nursing are in other states. <br /> 50 Senator Meyer said it varies state by state. He said his take is that there are probably <br /> 51 other pathways the state could take where everyone comes out fine. He said he thinks there is a <br />