According to a budget highlight published by the non-partisan Fiscal Research Division at the North Carolina General Assembly, there were four major impacts the Affordable Care Act had on the state’s Department of Health and Human Services budget.
1. The provision that hospitals could determine that individuals are presumptively eligible for Medicaid and process claims until a final determination was made by the state;
2. The expectation that individuals previously eligible for Medicaid that had chosen not to enroll, would enroll to avoid penalties;
3. All children up to 133 percent of the federal poverty level must be covered under Medicaid, which required the State to shift 71,000 children from Health Choice to Medicaid; and
4. The fact that North Carolina was not prepared to apply the new Modified Adjusted Gross Income (MAGI) eligibility criteria for enrollment effective January 1, 2014 which resulted in those individuals scheduled to be re-certified remaining on Medicaid rolls for a longer time period in FY 2013-14.
The North Carolina Department of Health and Human Services is made up of eleven divisions, which are categorized under four broad areas: health, human services, administration, and support. Last year the General Assembly enacted a $5.1 billion budget for HHS, but that isn’t the total cost of services in North Carolina. Some of the health programs are funded through other means, such as the federal government. If we take total expenditures in HHS for the fiscal 2014-15 year, the amount is closer to $19 billion.