Durham County Officials Lay Out Legislative Priorities, Including Medicaid Expansion and $1.9 Billion for Schools | News
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Wednesday, September 5, 2018

Durham County Officials Lay Out Legislative Priorities, Including Medicaid Expansion and $1.9 Billion for Schools

Posted by on Wed, Sep 5, 2018 at 10:35 AM

Expanding Medicaid, improving social services, and combating opioid overdoses are among the priorities Durham County wants legislators to take on in their next long session.

Durham County commissioners and staff discussed seventeen preliminary legislative goals during a work session Tuesday, outlining policies and funding for which the North Carolina Association of County Commissioners should lobby the state. Most fell within the purview of social services and public health, as well as transit.

The list will go to the NCACC along with goals from other counties, which will get narrowed down before being delivered to legislators in January. Commissioners on Monday reviewed but did not finalize Durham's proposals. They could still be tweaked or consolidated.

One asks the state to float a $1.9 billion bond to support school facility needs statewide. Advocates, including teachers who marched en masse on the legislature in May, had pushed for a $1.9 billion bond measure to be on the ballot for voter approval this November, but GOP legislators said they didn't want to borrow the money. Another goal supports more funding for teacher salaries and classrooms, particularly in light of new caps on K–3 classroom sizes, which means local school districts will need more rooms and more instructors.

Several deal with Medicaid. Under the Affordable Care Act, states were given the option to expand eligibility for Medicaid—which pays providers for services to children, pregnant women, low-income people, the elderly, and the disabled—with states paying up to 10 percent of costs and the federal government covering the rest. North Carolina is not among the thirty-four states to take the opportunity.

In addition to expanding Medicaid, county staffers want to see Medicaid support community paramedicine programs—community interventions aimed at reducing hospitalizations—that are currently operating across the state but get no Medicaid or Medicare funding.

North Carolina is planning to transition its Medicaid from a fee-for-service model to prepaid health plans, which could affect some provisions county staffers want to continue. One goal asks that the state maintain a process by which Medicaid is billed directly for non-emergency medical transports provided by local emergency services. Another goal asks that the state continue to reimburse EMS agencies annually for services.

Also on the public health front, EMS wants to see legislation addressing the "daily shortages of critical medications used in the prehospital setting." According to county staff, EMS often uses generic medications, production of which has been squeezed by drug companies because they aren't profitable.

More broadly, county commissioners and Durham EMS suggested goals seeking legislation and funding in support of programs combating opioid overdoses, both in the community and in emergency departments.

"We need to have alternatives of care for patients with substance abuse disorders," a draft goal reads. "This includes harm reduction strategies, acute inpatient detox, as well as rapid response teams. "

The goals don't specifically mention the Durham-Orange Light Rail Transit project—which was recently undercut by the state, leaving Durham county to fill a $57 million shortfall—but do advocate for additional state transit funding, both for public transportation projects and vehicle replacements.

Another goal asks for funding to fully implement the Juvenile Justice Reinvestment Act, which effective next year means sixteen- and seventeen-year-olds will be prosecuted as juveniles, rather than adults, for many offenses. That goal comes with a host of recommendations for how that legislation should be amended and implemented.

The rest concern social services—particularly child welfare as the state gets ready to roll out new standards. Those include increasing funding for Adult Protective Services and Guardianship Services for vulnerable and disabled adults; preserving federal and state grants that support needy families; increasing state funding for child welfare services so that non-federal costs are split evenly between the county and the state; revising and enforcing social worker caseload limits; and fully funding implementation of House Bill 630, which puts in place more social-services oversight.

Social services director Ben Rose told commissioners that if he had to narrow his wish list, his priorities would be the equal split for child welfare expenses and the additional funding for Adult Protective Services. Durham County, like counties across the state, has seen significant growth in the number of children in foster care, with an increasing portion of funding coming from the county. According to Rose, in fiscal year 2016, the county contributed 77 percent of funds for Adult Protective Services, while the state contributed 3 percent. 

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