Medicaid from the County Perspective

1
Medicaid from the County Perspective

• Breeden Blackwell, NCACC President
• Cumberland County Commissioner
• David Young, NCACC 3rd Vice President
• Chair, NCACC Human Resources Steering Committee
• Buncombe County Commissioner

2
Medicaid Critical for NC

• Medicaid covers elderly disabled, as well as
  kids families
• Medicaid covers high-cost care when no private
  insurance

3
Medicaid Critical for NC

• Medicaid supports public health providers
• County health departments public hospitals
• Without Medicaid, public agencies pay 100
• Medicaid adds 8.2 billion to NCs economy

4
Counties Required to Match All Medicaid Services

• 2004-05 state estimates for counties 440
  million
• 67 increase since 2000
• National estimates project a 15 per annum
  increase

5
County Revenues Insufficient for Medicaid
County Medicaid increasing 10 annually
County property tax base increasing 7.7 annually
6
State Requires County Medicaid Funding

• No federal requirement
• State law mandates 15 non-federal share for all
  services
• 5.4 of total Medicaid expenditures
• Counties pay 5.4 for their Medicaid residents
  receiving servicesburden is on individual
  counties

7
County Medicaid Funding Unusual

• No federal requirement
• New York only other state requiring county
  participation in all Medicaid services
• 15 states require some participation, usually for
  services in county-owned facilities
• 28 of 45 states reported no county participation

8
Counties Also Fund Medicaid Administration

• 2004-05 state estimates for counties 71
  million
• State federal laws determine who is eligible
• County employees do the work
• Counties pay full non-federal share of Medicaid
  administration
• Federal dollars support 50 of admin. costs
• No state support for county admin costs

9
Counties Cant Influence Medicaid Eligibility

• Eligibility is determined by strict state
  federal requirements
• Counties dont set Medicaid policy, eligibility,
  services, provider rates
• State federal decisions alone
• Must be uniform statewide
• Counties have NO control over biggest county
  budget driver

10
County Medicaid Funding Inappropriate

• Medicaid must be uniform statewide
• Property taxes most suitable to support flexible
  service levels
• Statewide uniformity in services demands
  statewide uniform tax base
• Counties cant control fastest growing budget
  line-item
• Medicaid crowds out education, homeland security,
  economic development
• NC county requirement an anomaly
• Poorest counties hardest hit with fewest
  resources

11
Medicaid Eligibles Determine County Costs

• 40 counties have Medicaid eligibles gt 20
  population
• 20 of these have Medicaid eligibles gt 25
  population
• 11 of these have Medicaid eligibles gt 30

12
North Carolina Medicaid Eligibles Per Capita
Camden
Alleghany
Northampton
Currituck
Gates
Ashe
Stokes
Surry
Rockingham
Person
Caswell
Warren
Vance
Pasquotank
Hertford
Granville
Halifax
Watauga
Wilkes
Perquimans
Yadkin
Orange
Forsyth
Mitchell
Chowan
Guilford
Avery
Bertie
Alamance
Franklin
Durham
Alexander
Nash
Caldwell
Davie
Yancey
Edgecombe
Madison
Washington
Martin
Wake
Iredell
Davidson
Burke
Tyrrell
Dare
Chatham
Randolph
Wilson
Catawba
Rowan
Mcdowell
Buncombe
Beaufort
Pitt
Johnston
Haywood
Hyde
Lincoln
Greene
Swain
Rutherford
Montgomery
Cabarrus
Lee
Henderson
Harnett
Graham
Wayne
Gaston
Jackson
Lenoir
Polk
Stanly
Moore
Craven
Cleveland
Mecklenburg
Transylvania
Cherokee
Macon
Cumberland
Pamlico
Richmond
Clay
Jones
Anson
Union
Sampson
Hoke
Duplin
Medicaid Eligibles as Percent of Population
Onslow
Scotland
Carteret
Robeson
Bladen
Pender
(20 counties)
New Hanover
gt25
Columbus
Brunswick
(64 counties)
15 - 25
(16 counties)
lt15
13
Medicaid Impacts All Counties Some More So

• 15 counties spend more than 10 of budget

14
Medicaid Impacts All Counties Some More So

• 48 counties spend more on Medicaid than school
  construction, renovation, other capital
• 5 of these spend more on Medicaid than school
  current expense

15
Cumberlands Story

• 2004-05 County Costs 12.9 million
• 56 increase in 5 years
• 18 population Medicaid eligible

16
Counties Ask For Relief!

• NCACC 1 2003-04 GoalMedicaid relief
• Seek legislation to implement a 6-year phase out
  of county participation in the costs of Medicaid,
  beginning with a cap at current costs in the year
  2003
• Medicaid relief goal for 5 years
• Year-long Fiscal Task Force focus recommendation

17
NCACC Committee Considers A Range of Proposals

• Cap, then phase out
• Use Low wealth school formula
• Give Supplemental funding
• Phase out over five years
• Phase out over four years
• Phase out over five years with immediate help for
  Tier 1 Counties

18
NCACC Committee Conclusions

• ALL counties need help
• If Medicaid hurts one county, it hurts all
  counties
• A cap on growth helps all
• Targeted assistance for counties with high
  Medicaid eligible populations

19
NCACC Committee Recommends Medicaid Relief

• Proposal for 2005-06
• Cap county Medicaid costs at 2004-05 levels
  beginning 2005-06
• Target additional relief to counties with high
  Medicaid populations
• State avg 17.4
• Phase out county share of Medicaid

20
Other Options

• We are open to other ideas
• Every dollar helps

21
Counties Speak Out

• Alexander County, Norris Keever, Chair
• Gaston County, Pearl Burris-Floyd, Commissioner
• Robeson County, Noah Woods, Commissioner NCACC
  Immediate Past President
• Bertie County, Zee Lamb, County Manager
• Jones County, Larry Meadows, County Manager