President's Perspective
Counties tell of Medicaid’s true costs

Also see:
Counties present case to Medicaid commission

I was privileged and honored on Tuesday, Nov. 16, to represent our Association and all of North Carolina’s counties before the General Assembly’s Blue Ribbon Commission on Medicaid Reform.

President's Perspective By Breeden Blackwell President's Perspective Archive

This was a wonderful opportunity for us to present our side of the Medicaid story to the commission, which included several influential members of the state House and Senate. In addition to my testimony, NCACC Third Vice President David Young of Buncombe County, NCACC Past President Noah Woods of Robeson County, NCACC Board of Directors members Pearl Burris-Floyd of Gaston County and Norris Keever of Alexander County, Jones County Manager Larry Meadows and Bertie County Manager Zee Lamb offered testimony on Medicaid’s impact on county budgets.

Medicaid relief has been our Association’s No. 1 goal for several years, but with the state going through its own belt-tightening over the past four years, our pleas for help have not been answered. Our appearance in front of the Blue Ribbon Commission on Medicaid Reform, however, may be a sign that our turn is coming.

It’s a familiar refrain, but one worth repeating – North Carolina and New York are the only two states in the nation that require counties to fully participate in all aspects of Medicaid funding. This is an exclusive – and expensive – club that we would rather not belong to.

For the current fiscal year, North Carolina counties must pay $440 million, a 14 percent increase over last year alone and a 67 percent increase over the past five years. National estimates project a continuing 15 percent per annum increase.

Since 1998, county Medicaid expenses have increased more than 10 percent per year while our property tax base has increased at 7.7 percent annually. The only way to manage this revenue gap without cutting other vital services is to raise property taxes.

Not only do we pay for Medicaid services, but we pay for Medicaid administration to the tune of $71 million a year. Federal and state laws determine who is eligible, but county employees, under our county departments of social services, actually do the work in determining who meets these eligibility requirements.

Counties have no say in who is eligible, which services are provided or even how much providers are paid. All decisions regarding county Medicaid costs are made exclusively by our federal and state partners, leaving us with no control over one of our biggest budget drivers.

Our poorer counties have even smaller tax bases to support these costs, leading to more inequities. A recent report by the Public School Forum showed that the education spending gap between the state’s poorest and wealthiest counties is more than $1,600 per student.

Local dollars should support local services, and citizens should be able to have an influence in what they are willing to pay for. Federal law mandates statewide uniformity in the Medicaid program, so county flexibility is not only impossible, it’s illegal.

Medicaid is an extremely vital program, and our counties realize the importance of Medicaid. Not only does it cover the poor, Medicaid covers those who are medically needy. It is also an important economic driver in many of our communities, bringing in much-needed federal dollars to support our local hospitals and health-care providers.

County participation in Medicaid funding is a bad match, however. The annual increase in our property tax base is not enough to cover the annual increase in Medicaid costs, leaving other critical infrastructure needs, such as schools, unmet.

When our membership meets in High Point on Jan. 13-14 to determine our legislative agenda for 2005-06, Medicaid relief is once again expected to emerge as one of our top priorities. I urge commissioners around the state to attend the Legislative Goals Conference and voice your concerns and opinions. I also urge you to educate your legislators about this issue and remind them that county government is a partner with the state.

Our legislative staff and membership have worked diligently in recent years to raise the awareness level for this issue among members of the General Assembly. Our appearance at the Blue Ribbon Commission on Medicaid Reform’s recent meeting is evidence of the progress we are making on this issue.

Now is not the time to rest on our laurels, however. Working together, I firmly believe we can accomplish our long-range goal of eliminating the county share of Medicaid services costs.