Rate cut reversal?

Worried about steep cuts in Medicaid rates for services county public health offices provide low-income pregnant women and troubled children, child and health advocates last week talked about sick infants dying and public health offices possibly having to fire nurses they couldn't afford. 

After the outcry, Dr. Craigan Gray, the state's Medicaid director, said rate cuts for case management for the children and pregnant women's programs would remain at 19 percent, rather than jump to near 40 percent."It leaves public health a few dollars better off than the 40 percent cut," he said. 

The case management cuts were to the maternity care coordination, child services coordination, health check and early intervention programs. 

Gray said the decision to keep the cut at 19 percent was independent of the public criticism.

 "We've been thinking about this for a long time, and talking about this a long time," Gray said in an interview last week. "It's not a new idea. The direction has been headed that way for many weeks."

Keeping the 19 percent rate reduction will cost the state about $1 million, he said. 

Gray said the concerns about public health offices not being able to pay bills were overblown. Every year, the federal government settles accounts, and pays local offices for their actual costs, he said. To help public health offices keep up with their bills, the state had decided to settle costs every three months, he said. 

Lynette Tolson, executive director of the N.C. Association of Local Health Directors, said Monday she had not heard from the Medicaid office that it would not go through with the 40 percent cut, or that it would go to quarterly cost settlements. 

"This has been our rollercoaster," she said. "We get information from different people, a legislator, it could be from anyone.  The only thing we know there's going to be a 36 percent to 39 percent cut in rates. There's nothing else formal that's come out."

Even if the public health offices will get the higher rate, there are still questions about how the programs will operate, she said. 

Tom Vitaglione, senior fellow with Action for Children N.C., also heard rumors that the public health services would get the lesser rate cuts, and thought the public pressure helped reverse the state's decision. 

'I'm just disappointed we had to go this far," he said.