When the tooth fairy doesn’t come

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RALEIGH — Back in June, I was among more than a few political observers who weren’t impressed as legislators patted themselves on the back for passing in a state budget well before the start of the July 1 fiscal year.

Democratic legislators, Gov. Beverly Perdue and advocates on the left had been arguing for weeks with the Republican legislative majority over spending cuts to the public schools.

My complaint, one shared by a few others who had studied the plan, was different.

The budget wasn’t balanced.

Oh, sure: On paper it was balanced. It has to be. The state constitution requires it.

But anyone who has seen more than a few of these spending bills put together could recognize a big, shining lie sitting there among the numbers and the delineated cuts: something in the neighborhood of $200 million in unrealistic, and likely to be unrealized, Medicaid savings.

Shockingly enough, state legislators are now beginning to hem and haw that their expected savings in the health care program for the poor might turn into unexpected red ink.

Unexpected, I suppose, if you believe in a tooth fairy or a federal bureaucracy that moves with due haste and deliberation.

That seems to be where the blame is being laid: at the feet of a federal bureaucracy that has to approve waivers before states can change Medicaid administration rules. Federal approval is required because the feds provide about three-quarters of the money for the program.

In North Carolina, the total spending comes to roughly $12.8 billion. State taxpayers provided about $3 billion.

In order to achieve $350 million in savings, the state budget called for having the rule changes in place by Oct. 1.

The problem is that the feds typically don’t approve Medicaid waivers that fast. Starting this month, every day that goes by without the new rules is a day that the budget gets a little bit out whack.

So far, of 47 requested changes, federal Medicaid officials have approved one.

Besides looking for savings from the rule changes, legislative budget writers also hoped to squeeze another $90 million from a program called Community Care, in which primary care doctors receive incentives for steering Medicaid patients into preventative care or lifestyle changes that save money over the long haul.

It may be a worthwhile program, but the $90 million figure also looks a lot like a wish and a prayer.

To be fair to legislative Republicans, it’s not as if their Democratic predecessors didn’t engage in their own budget chicanery.

Nearly a decade ago, former Gov. Mike Easley called legislators on what were obviously unrealistic revenue projections. Democratic budget writers also enjoyed avoiding responsibility for budget cuts by handing over the job of the specifics to state agencies while tagging the cuts with the euphemism “negative reserves.”

So, both sides can play fast and loose with the numbers.

But let’s not pretend that these Medicaid savings, when they don’t happen, mean much else.

Mooneyham writes about North Carolina politics for the Capitol Press Association.