Medicaid relief for local governments tops the legislative wish list for area county managers as the North Carolina General Assemble prepares to head into session next week.
“Our Medicaid relief represents 7.5 percent of our general fund budget,” said Linda Jones, Warren County manager. “That’s $1.6 million we spend on Medicaid.”
Halifax County Manager Matthew Delk said his county is hit even harder.
“The Medicaid burden is, for us, extensive,” he said. At more than $5 million per year, he said, “It takes up about 25 percent of our general fund expenditures.”
While Jones expresses a bit of trepidation at the prospect of the state taking on the Medicaid burden but then passing some other expense to the counties – “We don’t want to get into the (expensive) road maintenance business,” she said, that is not a concern for Delk.
“There is nothing else they (the General Assembly) could do that would affect us as much as the Medicaid costs,” he said. “We are one of the highest percentage counties, in terms of (our population’s) eligibility for Medicaid in the state.”
Medicaid is a federal program aimed at providing medical care for families and individuals from low-income households. While the federal government pays for a portion of the program, much of the cost is passed on to states. North Carolina is the only state that, in turn, passes some of that cost to localities, requiring counties to pay 15 percent of Medicaid costs not covered by federal money.
Last year’s General Assembly adopted a partial, one-time relief program, setting aside $27.4 million to help local governments with any increases in Medicaid spending in the current fiscal year over the previous year’s levels.
“If nothing else, we want them (legislators) to do what they did this year,” Jones said. “Cap it at the 2005-2006 level.”
Both county managers find sympathetic ears among their local representatives in the General Assembly. Both Michael H. Wray, whose 27th District includes parts of Warren, Vance and Northampton counties, and Lucy T. Allen, whose 49th District includes Franklin County and parts of Halifax County, say they support the move in principle.
“That’s the number one request of all rural communities,” Wray said. But, he said the challenge is finding a way to pay for the cost if the expense is shifted from the counties.
“It will be an ongoing expense,” Allen said. “It’s a half billion dollars, and we’ll have to fund that every year. It’s the right thing to do, but the political will to do that will involve being able to take a look at what revenues the state can provide, in addition to economic growth.”
In other words, will the state be forced to shift other expenses to local governments, or raise additional revenue through taxes and fees.
“There have been many ideas,” Wray said. One of those would be to allow local governments to levy an additional one percent sales tax, with that money earmarked for local Medicaid expenses.
Allen said she’s hopeful increased economic growth, and the tax dollars that generates, will fuel most of, if not all, of the money that would be needed to assume the local Medicaid cost.
Whatever the decision, she said a resolution to the issue isn’t likely in this session of the General Assembly, but some progress will be made.
“I’ve always believed the direction you’re going in is as important as the goal. If we can’t take care of the whole half billion at one time, I hope we can do enough to give county commissioners the confidence we are going to reach that goal.”
She also doesn’t believe legislators from more urban areas of the state, where the Medicaid expense makes up a tiny portion of budgets because of additional sales tax and other revenue, will stand in the way of finding Medicaid relief for the more rural areas.
“Most legislators have a statewide as well as a district view,” she said. “If we are able to do something, it would benefit the whole state. It would allow the counties in the northeast part of the states to use that money to do some self-help and fund initiatives for growth and put the money into education that we need to put into education.