02/21/05 — County seeks releif from Medicaid expense

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County seeks releif from Medicaid expense

By Barbara Arntsen
Published in News on February 21, 2005 2:02 PM

The Wayne County commissioners are asking for relief. They want the General Assembly to remove some of the burden of Medicaid expenses.

The county pays $6.7 million, or eight percent of its budget, for the treatment of people who are eligible for Medicaid -- 22 percent of the county's population.

"We spend 12 cents of the 66-cent tax rate on Medicaid," said County Manager Lee Smith.

North Carolina is one of only two states that requires comprehensive county cost sharing in its Medicaid program, according to a recent report on the state program.

Established by the federal government in 1965, Medicaid is a national health insurance program for low-income persons. It is a jointly funded by the federal, state and county governments.

Though the federal government provides guidelines, each state determines its own eligibility standards and scope of services and administers its own program.

In a study commissioned by state lawmakers, Carol Shaw of the Legislature's Fiscal Research Division, said that counties began paying into the Medicaid program more than 30 years ago.

Ms. Shaw says that in the 1971 legislative session, Medicaid cost sharing started out at 10 percent of the non-federal share. Later, it was decided, because of cost increases for long-term care, and because some counties still owned nursing facilities, that it should be increased to 15 percent.

Now the actual rate the counties pay varies each year, depending on what is outlined in the state's budget bill.

"There's no ceiling on Medicaid, and the growth rate of the program concerns me," Smith said.

Commissioner Andy Anderson said the program was such a major expense for the county that it was "hard to get things done that need to be done."

Anderson said the federal government was opening the program up to allow more people eligibility.

A report on Medicaid reform recommended that lawmakers first cap costs, and then phase out county payments by 2011.

The report was written by a Blue Ribbon Commission formed by the General Assembly to examine the state's Medicaid program and make recommendations for reform. The 16 members of the Commission consisted of legislators, health care officials and local government representatives.

The phase-out process should begin in the 2005-2006 fiscal year, said the report. It would reduce the county share by 2.5 percent each year, until the county share reached zero percent.

The Commission also recommended that the state Department of Health and Human Services develop and implement systems to reduce fraud and abuse within the Medicaid system of care.

Wayne County's commissioners passed a resolution last week asking for relief.

"It's a crisis," Smith said. "We have to have Medicaid relief for counties."