NCGA Week in Review

March 2, 2018

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A number of interim committees met this week with one common thread runningthroughout the conversations: health. Committees discussed issues includingthe vocational training and support for individuals with intellectual anddevelopmental disabilities (IDD) and an update on the status of NC’sMedicaid waiver application. Additionally, the filing deadline for the 2018elections passed on Wednesday.

Filing for 2018 Elections Ends

Candidate filing for 2018 elections ended on Wednesday afternoon. All 170seats in the state legislature, and 13 seats in US Congress will be on theballot, as well as a number of county officials. Primaries will be held onMay 8 and the general election will follow on November 6.

Clickherefor a 2018 candidate tracker from the NC FreeEnterprise Foundation.

Record Number of Contested Legislative Races

After a strong push from the Democratic Party to have one candidate on theballot in every House and Senate district in the 2018 elections, only onelegislative seat will beuncontestedin November. This stands out in contrast to recent years, the 2016 electioncycle included 73 uncontested legislative seats. Officials of both partiesexpressed excitement about the competitive nature of the upcoming electioncycle.

More Primaries for Legislative Incumbents

In 2016, eight incumbent senators, four from each party, faced primaries.In 2018, nine Republicans and three Democrats will have primaries. On theHouse side, 19 Republicans and eight Democrats will face primary opponentsthis year. Two years ago, eight Democrats and seven Republicans hadprimaries.

While incumbency was considered when the state’s legislative maps wereredrawn in 2017, several members are double-bunked in 2018:

  • In Senate District 45, Republican Sens. Deanna Ballard (Watauga) and Shirley Randleman (Wilkes) will compete in a two-way primary.
  • There will be a three-way primary featuring Republican Sens. Dan Barrett (Davie), Joyce Krawiec (Forsyth) and newcomer Peter Antinozzi in Senate District 31.

What About Congressional Elections

NC’s 2018 congressional races also have potential to becompetitive. Twelve of the 13 seats will be contested and more than 60 candidatesthrew their name in the ring. The NC delegation is currently comprised of10 Republicans and 3 Democrats. NC is considered by many to be a “purple”state, which will put these elections, the first since President DonaldTrump took office, in the spotlight.

Behavioral Health Plan Discussed by Subcommittee

The Behavioral Health Subcommittee of the Joint Legislative OversightCommittee on Medicaid and NC Health Choice and the Joint LegislativeOversight Committee on Health and Human Services held their first meetingon Tuesday to discuss the statewide behavioral healthplanthat wassubmittedto the General Assembly by the Department of Health and Human Services(DHHS) in January.

What’s Included in the Plan?

DHHS Assistant Secretary for Policy Walker Wilson, Deputy Secretary forHealth Mark Benton and Deputy Secretary for Medical Assistance Dave Richardoverviewedthe plan, and reviewed the current challenges facing the behavioral healthsystem, including the opioid epidemic and unmet mental health care needs,particularly in rural areas of the state. Recommendations in the planinclude:

  • Expanding the use of telemedicine.
  • Better utilizing the behavioral health service workforce.
  • Accelerating the integration of physical and behavioral health.
  • Increasing services for young children and support for their families.
  • Establishing or strengthening community collaboration.

Health & Human Services Oversight Receives Updates

The Joint Legislative Oversight Committee on Health and Human Services meton Wednesday.

DHHS Secretary Updates Committee

DHHS Sec. Mandy Cohen provided herremarksto the committee. She first highlighted actions the Department has taken toassist the transition of the Cardinal Innovations Board of Directors. Sec.Cohen reported that the Board has pledged to spend at least $3.8 million onan enhanced behavioral health initiative. The Secretary also addressed the2017-18 flu season, noting that there have been 200 flu related deaths inthe state this season.

Local Health Departments Present Legislative Priorities

President of the NC Association of Local Health Directors and Director ofthe Union County Health Department Dennis Joyner presented anoverviewof the responsibilities of local health departments and the challenges theyface – primarily stretching small budgets to meet all of their obligations.Pitt County Health Director Dr. John Morrow noted that state funding forcommunicable disease has not kept pace with the number of outbreaks.According to Granville-Vance Health District Director Lisa Macon Harrison,NC ranks 44 in public health in per capita state spending.

Health in Prisons and Jails Reviewed

The committee heard two presentations on the protocols surrounding prisonand jail inmate health.

First, DHHS Division of Health Service Regulation Construction SectionChief Steve Lewispresentedan overview of the Department’s jail death oversight policies andprocedures. The Construction Section conducts compliance reviews when jailsreport an “in-custody” death of an inmate. According to his presentation,38 jail inmates died in 2017, the majority of which died of natural causes.

Then, Department of Public Safety Deputy Secretary of Administration JoePraterpresenteda review of the inmate health care and the implementation of a healthinformation exchange for inmates.

Intellectual & Developmental Disabilities Committee ReviewsWorkforce Inclusion

Yesterday, the Legislative Research Committee on Intellectual andDevelopmental Disabilities held their second meeting to hear presentationsfrom DHHS and other organizations on the inclusion of individuals with anI/DD in the workplace.

DHHS & Organizations Overviewed Available Programs

In theirpresentation, the Department identified the needs of individuals with an I/DDtransitioning from a K-12 environment to post-secondary education or work,highlighted available programs, and made several recommendations based onexisting gaps, including:

  • Fostering attitudes of high expectations for youth with an I/DD beginning at birth.
  • Promoting understanding of the definition of competitive integrated employment within NC business community.
  • Increasing capacity for customized employment.

The committee also received presentations from the following stakeholders:The ARC of NC,The Autism Society of NC,Alliance Disability AdvocatesandOE Enterprises, all of whom emphasized the importance of empowering individuals with anI/DD through employment.

Medicaid Oversight Discusses 1115 Waiver

The Joint Legislative Oversight Committee on Medicaid and NC Health Choiceheld their third meeting of the interim on Wednesday, where they receivedupdates from DHHS, including an update on the status of the state’s 1115Waiver application.

What’s the Status of the Waiver?

First, Steve Owen of the NCGA’s Fiscal Research Divisionreviewedthe amended waiver, including an overview of provisions that are notconsistent with existing state law. DHHS Secretary Mandy Cohen, DaveRichard and DHHS Deputy Secretary for Policy Christen Linke Young followedwith areviewof the Department’s work with the federal Centers for Medicare &Medicaid Services (CMS). According to the presentation, DHHS and CMS havehad ongoing meetings for months to discuss the waiver.

Anything Else?

Yes, the committee also received updates on Medicaid and NC Health Choiceenrollment levels, including enrollment in theFamily Planningprogram,finances, and an overview ofMedicaid Dashboards. According to Steve Owen, enrollment has roughly tracked in line withexpectations and is 3.6% higher than this time last year. Medicaidexpenditures also continue to be favorable.

Medical Education Subcommittee Reviews Loan Repayment & ApprovesCommittee Report

Yesterday, the Subcommittee on Medical Education and Medical ResidencyPrograms, a joint subcommittee of the Joint Legislative Oversight Committeeon Health and Human Services and the Joint Legislative Education OversightCommittee, held their second meeting of the interim. The committee heardpresentations on loan repayment programs available to medical providers inrural NC and adopted their final report.

Loan Repayment Programs Encourage Practitioners in Rural NC

DHHS Office of Rural Health Director Maggie Sauerpresentedto the committee on existing state and federally supported loan repaymentprograms for health practitioners in rural areas of the state. Saueremphasized that these programs are not a silver bullet and suggestedexpanding telehealth to improve health, employment and education in ruralNC.

Subcommittee Report Proposes Medical Education & ResidencyStudy

The subcommittee adopted theirreport, which overviews the committee’s activities and includes a legislativeproposal to continue the work of the subcommittee in the interim betweenthe upcoming short session and the 2019 long session. The report must beapproved by both overseeing oversight committees.

A Look Ahead to Next Week

Monday, March 5, 2018

8:45 AM House Select Committee on Strategic Transportation Planning andLong Term Funding Solutions

Tuesday, March 6, 2018

9:00 AM Task Force on Sentencing Reforms for Opioid Drug Convictions

10:00 AM Joint Legislative Education Oversight Committee

1:00 PM Joint Legislative Administrative Procedure Oversight Committee

1:00 PM Joint Legislative Commission on Energy Policy

Wednesday, March 8, 2018

9:00 AM Joint Legislative Oversight Committee on Information Technology

9:00 AM Joint Legislative Transportation Oversight Committee

1:00 PM Joint Legislative Economic Development and Global EngagementOversight Committee