Minutes-02-27-2023-Legislative Breakfast

Browse Search

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