Republican legislators think that changing Medicaid’s oversight structure will fix problems in predicting costs for the federal/state health care program. That’s not necessarily so, given how the rolls change depending upon eligibility, population and economic conditions.
North Carolina’s $14 billion program serving low-income parents, children, seniors and people with disabilities isn’t poorly run, and its costs haven’t been skyrocketing. The legislature’s own fiscal analysis shows that Medicaid’s medical costs per person have declined overall by more than 11 percent since 2008 while Medicaid spending nationally has increased 6 percent using the same measure.
Advocates for the poor are rightly suspicious of Republicans who now talk of setting up an independent board to run Medicaid. After all, GOP lawmakers and Gov. Pat McCrory have balked at expanding Medicaid.
Under the proposed plan, a board of political appointees would have a budget, and if the budget appeared to be running over, the board could cut services to make up the difference. This would save lawmakers the “trouble” of finding additional funds during the year to plug gaps in Medicaid.
But Medicaid isn’t some road-paving program or agency with the leeway to cut travel budgets or forgo additional staffers. Cutting Medicaid services would mean cutting health care to the poor and disabled. That is something lawmakers should not even think about. The adults and children covered by Medicaid don’t have choices about whether they get sick and need a doctor or a hospital. Their expenses simply must be covered.
The Department of Health and Human Services has control over Medicaid now. For all the problems DHHS has had, it should retain oversight of Medicaid, where responsibility can be easily traced and where answers can be found. Medicaid can’t be handled like just one more cog in the bureaucracy.