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Yahoo
6 days ago
- Business
- Yahoo
As NC budget writers get down to brass tacks, a crisis in corrections looms large
NC Department of Adult Correction Secretary Leslie Dismukes tells members of the Senate Judiciary Committee the state is now faced with 40% vacancy rate for correctional officers. (Photo: NCGA video stream) When North Carolina House and Senate budget writers begin hammering out a compromise between their two proposed budgets, one of the more pressing problems will be how to address the crisis in North Carolina's prisons. During a confirmation hearing this month, Department of Adult Correction Secretary Leslie Dismukes told lawmakers the state is now faced with 40% vacancy rate for correctional officers. Three prisons currently have a vacancy rate over 60%, and at another 10 the vacancy rate hovers at over 50%. 'The General Assembly has been our partner and has dedicated resources to help us address this issue. But I'll be honest, it's still a struggle,' Dismukes told members of the Senate Judiciary Committee. The Department of Adult Correction (DAC) has almost 32,000 people in physical custody and another 77,000 under community supervision. State employees in the department are working 12-hour shifts and mandatory overtime to meet minimum staffing levels in the prisons. Flanked by law enforcement officers, Dismukes said she has workers who are dealing with exhaustion and child care needs, that many cannot afford. 'What is the department doing now to recruit new employees and what do you think needs to be changed to do to increase your recruitment?' Sen. Warren Daniel (R-Burke, McDowell, Buncombe) asked. Dismukes said recent raises have been helpful, but North Carolina lags its neighbors. 'We are for correctional officers in the bottom three in the country, and certainly in all of our surrounding states, we are at lowest,' she said. DAC urgently needs to keep qualified staff on board to train the new staff that are being recruited. 'Right now, we're in great danger of losing a lot of our talented staff who know how to do the job because we cannot pay them equivalent to other states or other industries within North Carolina,' Dismukes added. Rep. Phil Rubin (D-Wake) agrees with that concern. 'If you want to be a prison guard, you've got a lot of reasons not to do it here,' Rubin said in an interview this week with NC Newsline. Rubin said the House budget proposal offers a meager 2.5% raise for state workers and proposes getting rid of many positions that have been vacant for months. For DAC that would mean the loss of 400 correctional officer positions that are unfilled. 'We can't fill the spots. So, then we get rid of them, and we have too few prison guards, which endangers the ones that are there, and it drives them out of the job because their job just got harder and worse and they're still not getting paid better,' Rubin explained. 'Meanwhile, we're hearing about doubling the premiums and the deductibles on the State Health Plan.' Beyond just a modest pay increase, the state needs to make a commitment to ensuring the correction officers have a safe workplace. NCDAC has recorded more than $1 billion in deferred maintenance for the aging infrastructure in prisons. 'It's $1.4 billion of maintenance that needs to be done right now,' Dismukes stressed. 'Our fire suppression systems are outdated or completely inoperable in 23 prisons and several prisons don't have air conditioning.' Correction officials say it's not a matter of comfort. The lack of cooling systems in close conditions in an institutional setting can increase the risk of violence. A 2015 Columbia Law School report noted that the rise in older, sicker prisoners may also be more vulnerable to the heat. North Carolina has been working on a long-term project to cool its prisons since 2021. As of last summer, DAC was installing air conditioning systems in buildings containing the remaining one-third of the beds its staff supervises. Indoor environmental conditions aside, the agency learned during Hurricane Helene that it does not have the redundancies and system resilience to meet natural disasters. The storm forced the transfer of nearly 2,200 prisoners from five facilities in the western part of the state. Civil rights groups warned at the time that the emergency transfers exacerbated overcrowded conditions and the workload on correctional officers. 'We must make critical decisions about our prison locations to maximize staffing and return on investment for our infrastructure repairs,' Dismukes told senators. Another ever-present worry for DAC is medical costs. In fiscal year 2024, the department spent $400 million on health care. This fiscal year, that number is projected to rise to $425 million. 'These costs, we cannot avoid given the aging prison population and our duty of care to them,' warned Dismukes. 'We must take a look at our overall medical infrastructure and build the best prison medical system we can and create savings wherever possible.' Getting medical personnel to work in the correction system remains a challenge. The persistent and high vacancy rates for nurses have resulted in the use of contract or traveling nurses, a more expensive option for the state. Dismukes is expected to win confirmation from the Judiciary Committee at its next meeting. Sen. Danny Britt (R-Robeson) said the secretary deserves credit for her willingness to take on the challenge. 'It is probably one of the most challenging budget areas that we have to deal with, both on scale and funding,' he acknowledged. Britt said the Senate has done its best with salaries, earmarking an additional 5.25% raise for correctional officers combined with step increases. Probation and parole officers could get an additional 2% raise in the Senate budget. 'There's no real silver bullet, so hopefully if confirmed, you can come up with those answers outside of salaries that can fill these positions. We're willing to do whatever we can to assist. Hope you're willing to reach out.'
Yahoo
20-05-2025
- Health
- Yahoo
State Health Plan Trustees advance benefit changes with employees shouldering higher costs
The State Health Plan Board of Trustees has a $500 million deficit to close. As a result, new premium hikes are on the way for employees, retirees and their families to close the gap.(Stock photo by) State Treasurer Brad Briner has been sounding the alarm for months. Faced with a $507 million deficit, North Carolina's State Health Plan will require a combination of strategies to address the fiscal cliff and ensure the long-term care of the plan's nearly 750,000 teachers and state employees. On Tuesday, the State Health Plan's Board of Trustees gave its initial approval to a series of actions that would reorient the plan, incentivizing members to use 'bundled' participating providers or facilities. State employees and teachers would also be asked to do their part by paying higher health insurance premiums starting in 2026. 'We began this conversation in January around premium increases for the first time in eight years, a tack that nobody wanted to take,' said state Treasurer Brad Briner. 'But buried in the materials here, you'll see that what was going to be a $20 (monthly) premium increase at the lowest tier. It's now a $5 premium increase at the lowest tier.' Briner said significant time has been spent trying to insulate North Carolina's lowest compensated employees from increases as much as possible, while determining the highest and best use of the dollars that are available. Out-of-pocket maximums would not change substantially, he pledged. The State Health Plan is also taking steps towards eliminating all prior authorizations for independent primary care, another incentive for plan participants. Thomas Friedman, executive administrator of the State Health Plan, said state employees who are members of the plan can expect several changes in the months ahead. For starters, the names of the most common plans will change. The 70/30 plan will become the 'Standard PPO plan' with annual deductibles rising from $1,500 to $3,000 for individuals, and families seeing their deductibles rise from $4,500 to $9,000. The average monthly premium would jump from $25 per month to $40 per month and could be adjusted higher based on the employee's salary. The 80/20 plan will be known as the 'Plus PPO Plan' with annual deductibles rising from $1,250 to $1,500 for individuals, and from $3,250 for families under the current plan rising to $4,500. Those on the 80/20 plan would see their premiums jump from an average of $50 per month to $100. Higher income earners could see a monthly premium of $130. While the numbers may not be popular with state workers or teachers, trustee Dr. Brad Miller noted that on the private insurance market, individuals are paying an average premium of $119 a month, with families paying a premium of $532. What members pay for prescription drugs would also rise next year and in some cases substantially. Specialty medications (Tier 5) would increase from $350 under the current 70/30 plan to $600 under the new Standard plan. Friedman noted that manufacturer coupons exist for many high-end, specialty drugs, allowing patients to pay little or nothing at all. 'Why not have the manufacturers pay more if they're willing to do it?' Friedman offered. Coverage of the popular GLP-1 weight loss drugs remains 'under development,' but nutrition and weight loss coaching would be available to everyone. Moving forward, the State Health Plan is working to make it attractive to members – both financially and in terms of access – to engage with preferred providers. Tuesday's meeting of the Board of Trustees came as members of the state House advanced their own budget blueprint. Friedman said that both the House and Senate budget proposals have fully funded the requests of the State Health Plan at a 5% premium increase per year. 'Given everything going on in the state and how little the budget increased, we are a substantial portion of that, and we are very grateful that they listened.' Treasurer Briner also offered praise for the budget proposal emerging from the House. 'The House proposal fully funds the pension plan and increases funding to the State Health Plan to help in our effort to provide affordable, high-quality health care for state workers. Investments made in salary increases and cost-of-living bonuses will help ensure that the state can retain top talent.' But Tamika Walker Kelly, president of the North Carolina Association of Educators, said that the legislature should step up its funding, rather than ask school employees and state workers to shoulder higher health care costs. 'It's not only unfair, but it is unsustainable,' Walker-Kelly told the trustees. 'We are already facing a critical staffing shortage, more than 8,000 school positions were vacant at the start of this year and one-in-five teachers left the classroom over the past two years. If we increase the cost for those who stay, how will we fill the gaps and who will be there for our students?' Walker-Kelly said the decision is not simply about numbers on a spreadsheet; it is about the people who keep our schools and state services running. A vote by the board to set the premiums for 2026 is set for Mid-August. Open enrollment with the new 2026 rates will be October 13-31. Click here to view the full presentation to the State Health Plan Board of Trustees.
Yahoo
13-05-2025
- Politics
- Yahoo
NC workers join together to call on lawmakers to address some of their biggest needs
RALEIGH, N.C. (WNCN) — Dozens of state union workers gathered in front of the State Legislative Building in Raleigh on Tuesday for Political Action Day. As the General Assembly works on the state budget, union workers with UE 150 made sure they weren't forgotten about. Workers from Kinston to Morganton were in attendance to discuss understaffing in state facilities and how they're working with legislators to pass the budget for Fiscal Year 2026. The group is asking state leaders for a list of needs. That includes filling a $1.2 billion budget gap in the State Health Plan. 'The State must invest into the huge State Health Plan budget gap, and significant pay raises for state workers and retirees this year,' said Sekia Royall, a cook at O'Berry Neuromedical Treatment Center in Goldsboro and past president of UE150. UE 150 is also asking for an increase in state wages. The group says they want to see a $25 an hour minimum wage for state employees, that is a 20% increase in salary. 'Minimum wage is still $7.25, who's supposed to live off that?' said Charles Owens, Healthcare Tech with Cherry Hospital in Goldsboro. When it comes to UNC system workers, they're also asking to create sanctuary status to protect undocumented workers and students from federal enforcement agents. Overall, the organization says state employees are working in areas that are incredibly understaffed. William Young, a cook at Cherry Hospital, has seen it first hand. 'I work at a hospital and a lot of hospital workers are working long hours and not getting paid enough money and just absolutely getting stressed out,' said Young. You can view the full list of what they're asking for below. 2025-Political-Action-PrioritiesDownload Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
Yahoo
11-03-2025
- Health
- Yahoo
Local health systems oppose repeal of Certificate of Need
Mar. 10—dbeard @ MORGANTOWN — The years-long effort to repeal the Certificate of Need process for healthcare facilities and equipment took a blow on Feb. 24, but not a fatal blow, according to Gov. Patrick Morrisey. As Morrisey continues his push for repeal, the Dominion Post talked with Mon Health, WVU Medicine and the West Virginia Hospital Association for some local perspective on CON. But first, some background on what CON is. The state Health Care Authority oversees the CON process. All healthcare providers, the HCA explains, unless otherwise exempt, must obtain a CON before adding or expanding health care services ; exceeding the capital expenditure threshold of $5, 803, 788 ; obtaining major medical equipment valued at $5, 803, 788 or more ; or developing or acquiring new health care facilities. The CON program was enacted in 1977 and put under the HCA in 1983. The HCA says its goals are to control health care costs, improve the quality and efficiency of the healthcare system, encourage collaboration and develop a system of health care delivery that makes health services available to all residents of the state. The CON process, HCA says, is often associated with cost containment measures. It also, by legislative intent, allows for health services to be provided in an orderly, economical manner that discourages unnecessary duplication. HCA says some states have repealed their CON statutes, but 36 states and the District of Columbia retain some form of review. Three states limit their review to long-term care. CON review includes the determination of need, determined using CON Standards, which generally include population-based quantifiable need methodologies ; consistency with the State Health Plan ; and financial feasibility, which includes the evaluation of the reasonableness of proposed charges to patients and the determination if the expense and revenue projections demonstrate fiscal viability for the proposed project. Other review criteria include quality, accessibility, and continuum of care. HCA says, "The advantage of CON programs to the public is that they encourage accountability by providing an avenue for public comment, discourage or limit unnecessary services, and promote community planning. In West Virginia, the CON program offers some protection for small, often financially fragile, rural hospitals and the underinsured population they serve by promoting the availability and accessibility of services and, to some extent, the financial viability of the facility." The repeal effort This is not the first year that a CON repeal bill has been introduced, but it is the first year it was introduced on behalf of the governor. Morrisey's bill took form in twin Senate and House bills: SB 453, which is sitting idle, and HB 2007, which died in a procedural move in House Health on Feb. 24. Morrisey said later that week that he believes the majority of lawmakers agree with him that CON needs to be repealed. As Ogden News' Steven Adams reported, Morrisey said, "I want to protect citizens that are in need, and I want there to be a viable private health care marketplace. Right now, we're going in a direction where that's not happening. That's going to change. We're going to continue to push for policies that make a difference that put the people first, not the special interest. That's what we're working on." The Dominion Post contacted Morrisey's office for an update on his plans and they passed along his statement, "The fight to repeal Certificate of Need is not over. West Virginia currently pays more for hospital services than all but one state — while experiencing the worst healthcare outcomes. We must reduce the unaffordable price of healthcare and increase consumers' access to the services they depend on." His office said to expect future announcements on this front. A conservative coalition of the Cardinal Institute, Institute for Justice and AFP West Virginia backs Morrisey, saying CON laws hinders healthcare access, increase healthcare costs, lengthen wait times and lower quality of care, especially in rural areas. States that have repealed CON have seen no negative effects. The coalition says, "In short, CON laws are holding every West Virginian back from better access to more quality healthcare." But the healthcare professionals disagree. To some extent, they offer the same reasons for supporting CON, but we give each their own voice here. Mon Health System David Goldberg is president and CEO of Mon Health System and Davis Health System — Vandalia Health Northern Region, and executive vice president of Vandalia Health. He testified in favor of CON before the House Health Committee. He told The Dominion Post that he's worked in CON and non-CON environments, and it's a complex issue. About 75 % of West Virginians are covered by Medicare, Medicaid or PEIA, he said. "Certificate of Need covers the ability for us and our health systems and providers to be balanced, where we build things to be able to generate the revenue that's appropriate to invest in our healthcare system in balance." Without CON protections, he said, we could see providers putting everything in the more economically focused markets — such as the panhandles and the Morgantown-Clarksburg corridor. "You have health systems in Kentucky who would love to come over the border to reach into the southern quadrant of the state and be able to expand their reach. Will they have this in focus ? We do, on taking care of our own in West Virginia." Goldberg noted that there are no CON prohibitions from opening private practices. For instance, UPMC recently bought some MedExpress assets in order to build some urgent care centers. So there is competition, but CON prevents organizations from coming in with freestanding radiology centers that could harm small neighboring hospitals by draining their revenues. "For example, I have something that comes right into Monongalia County, that starts to negatively impact my ability to generate revenue. How do I support the Preston Memorials, the Webster hospitals and Webster Springs, the Stonewall Jackson Memorial Hospital that are predominantly Medicare Medicaid, then don't cover costs to begin with. So I think we have to be balanced." Goldberg said they've shared with Morrisey and the Legislature, "We think there's ways to modernize. We think there's ways to collaborate. We all want to improve our outcomes and improve the affordability and the cost structure, but Certificate of Need in a state like West Virginia, it maintains the ability of balance, and we need to have that, because the northern part of the state is not the same as the east, the west or the south." Goldberg said health systems across the state are planning more than $1 billion in healthcare infrastructure across the next five to 10 years. So there is competition already. "I think that competition makes us that much better for the communities we serve, but we want to be balanced in how we compete." Goldberg concluded, "I am mandated by the federal government, the state government and some locals how I operate. My reimbursement is set by contracts with payers, Medicare, Medicaid and PEIA. We are mandated and rightfully take care of our patients, regardless of their ability to pay, so it is not a free market. ... And I think let's modernize Certificate and Need, let's find ways to collaborate and do that." WVU Medicine We reached out to WVU Medicine for its views and were connected with Candace Miller, president and CEO of WVU Medicine Jackson General Hospital. A native West Virginian, Miller said she worked her whole career in Ohio, coming to WVU Medicine last June from a large system based out of Columbus. And when she got here, "The first thing I started scratching my head on was Certificate of Need. I was like, well, this is crazy. Why in the world do we do this ? This is, this is nothing but red tape, stupid, bureaucracy kind of thing." But it didn't take long for her to figure out, she said, that West Virginia is very different from other states. Without CON, her rural, critical access hospital would be at risk. Critical access hospitals must meet criteria set by the Centers for Medicare & Medicaid Services. Among the criteria, they must be located in a rural area either more than 35 miles from the nearest hospital or more than 15 miles in areas with mountainous terrain or only secondary roads ; maintain no more than 25 inpatient beds that can be used for either inpatient or swing-bed services ; and furnish 24-hour emergency care services seven days a week. Critical access hospitals receive higher federal reimbursements than other hospitals, though still less than the cost of delivering care. Miller explained, "Let's say a small hospital was built right beside me, and it's defined by five beds or more. I would lose my critical access hospital designation. ... If I lose my designation, I immediately start running in the negative." And operating margins here are slim, she said: 14 % where she previously worked, 2 % in West Virginia. Ohio has 250 hospitals of which 33 are critical access, she said. West Virginia has 72 hospitals total, with 21 of them critical access. And Ohio has 11.8 million people, compared to West Virginia's 1.7 million. "So, why does all that matter ? It matters because when you have a limited amount of people to serve, like we have in West Virginia, when you have these rural areas, like we have in West Virginia, you can pretty much, if you're big healthcare, big system, deep pockets, you can bully other providers out. And that limits access." Without CON, she said, a company could come in and set up a surgery or imaging center — two of the biggest-profit operations — and put a critical access hospital that has to provide more services out of business. "No one's going to come in and set up a business, a health care service line that's not going to make money. You just can't." Miller takes issue with repeal proponents who cite West Virginia's poor health statistics as a reason for repeal. West Virginia tops the nation proportionally for obesity and smoking — issues not tied to proximity to a healthcare facility. "And so it's not fair to say the limited access to care equals poor health outcomes when you're not taking into consideration other facts that play into poor health outcomes for our state." West Virginia Hospital Association Jim Kaufman is president and CEO of the WVHA. CON, he said, is a valuable tool used by states for appropriate health care planning, such as a sufficient population to support that program, and the overall impact on the delivery system in the state. Setting up a facility next to another one may simply drain the resources of the first one, he said, reducing access to care instead of increasing it. But a CON review can take into consideration location, and economic and healthcare impacts. "Now you have an understanding and you're making an informed decision because it has an impact on another hospital that will change their financial status and potentially threaten or weaken that facility, " he said. "So now, from a statewide planning perspective, you're making an informed, rational decision. That's appropriate planning." Kaufman said he appreciates that the Legislature is looking at this and gaining an understanding that healthcare is unique and unlike other sectors of the economy. "But we also applaud the governor because he recognizes that two of the biggest challenges with the West Virginia healthcare delivery system is workforce and our payer mix. We applaud the governor and his efforts to expand the state's economy and to get creative in trying to attract more people to the workforce. Which raised another issue: a healthcare professionals shortage, he said. It's national, but West Virginia's challenges include the high proportion of residents — 75 % — relying on government-backed insurance that pays less than the cost of care. The national average is 40.5 %. "So that's going to be a challenge right there when offering competitive salaries and keeping those professionals in the state, " he said. Another is the state's rural nature. "You actually need patient populations to support programs, which is part of the Certificate of Need discussion." Commercial insurance pays above cost, which allows institutions to support other programs, community needs, and cross subsidize the underpayment on the governmental side, he said. But if you have a high proportion on government programs, you have fewer resources to offer competitive salaries, to reinvest in capital. Kaufman concluded, "The hospitals all across West Virginia are really working hard and getting very creative to expand services. They're working together — you're seeing hospitals sharing certain specialists because there may not be enough volume in one community. Collectively, he said, the hospitals have invested more than $3 billion in new construction, new facilities, and new services. "I think they're really trying to address the real issue of how do you expand access. Touching on an issue Miller raised, tacking obesity, he said obesity efforts and hospital efforts are not the same. "Hospitals are working to improve the health of their community with the whole goal that they won't need healthcare services, because they get healthy. I think that's another piece that people forget, that is part of the delivery system that you could lose if you allow these cherry picking of services that the elimination of CON can bring."
Yahoo
10-03-2025
- Health
- Yahoo
Plans to increase state employee health insurance costs draw criticism
Thomas Friedman, executive administrator of the State Health Plan, state Treasurer Brad Briner, and state budget director Kristin Walker at the state health plan trustees meeting, March 7, 2025 (Photo: Lynn Bonner) State employees are criticizing plans to make their health insurance more expensive, saying options officials are considering will hurt hiring and recruitment efforts and tarnish a benefit of working for the state. The State Health Plan spends more money than it takes in. Its Board of Trustees is considering ways to prevent insolvency. State Treasurer Brad Briner is asking the health plan trustees to raise $500 million so it doesn't run out of money next year. His office has also asked the legislature to increase state contributions by 5% each year over the next two years for covered employees. That would amount to $97 million in the first year. The health plan's deficit is $1.4 billion over two years. The plan's Board of Trustees is considering how to balance proposed higher health insurance premiums with other increases to employees' out-of-pocket costs to help fill that hole. State Treasurer Brad Briner said the move was akin to 'putting out a fire.' Without action, the health plan will run out of money at the end of 2026, he said. Briner said he knows no one wants costs to go up. The health plan held premiums and out-of-pocket costs flat for seven years by dipping into reserves, he said, and cannot do it anymore. 'Unfortunately, we are now out of reserves,' Briner said. Health plan administrators have proposed salary-based premium increases, with a maximum $20 per month increase for the lowest-paid employees. Other changes, such as higher deductibles and increases to out-of-pocket maximums, are also in the mix. After reworking the health benefits plans, administrators will look to cost savings from hospitals to help cover the following year's shortfall. Trustees discussed options at a Friday meeting, but won't vote on a final plan until May. The board plans to set premiums in August. State employees told trustees the increases would be unaffordable. The state health insurance plan covers about 700,000 state employees, teachers, and dependents. 'As a state employee, we see having a decent health insurance plan as a buffer to low wages,' said Karina Hernandez, a licensed clinical social worker at Butner's Central Regional Hospital, one of the state's three psychiatric hospitals. 'We don't have many perks,' said Hernandez, a member of UE Local 150, the North Carolina Public Service Workers Union. 'Health insurance is important to us.' Kevin Thompkins, executive director of Human Resources at Vance-Granville Community College, said the plan should have five or six salary tiers to distinguish between middle-income and high earners. It's hard to hire full-time community college faculty, Thompkins said. Many in-demand specialists can make more money elsewhere. 'One of the big recruiting things we have are the pension and the State Health Plan,' he said. Increasing premiums and deductibles would seriously hinder the ability to hire and retain employees, he said. While the treasurer's office is looking to find savings from hospitals in the next stage of its plan to address the deficit, the State Employees Association of North Carolina wanted to look first at lowering hospital costs. SEANC's Suzanne Beasley told trustees it would be critical to make public how much hospitals are making before they look to employees to pay more. SEANC has been pushing for contract transparency so the public can know how much the health plan pays hospitals. 'State employees know that they are the low-hanging fruit you're always going to pick first,' she said. Dr. Kerry Willis, a trustee with a North Carolina medical practice, cautioned against big increases in out-of-pocket maximum costs, which could discourage people with chronic illnesses from seeking medical care. He doubted changing insurance benefits would save money. 'We'll save money looking at hospital costs and capping those,' he said. The board does need to look at hospital costs, said Dr. Brian Miller, a trustee who is a hospitalist and researcher at Johns Hopkins University. The immediate focus is on benefits because they have to do something fast, he said. 'Hospital contracts are not a fast process,' Miller said. 'Next year, we'll have other tools, including hospital costs. We'll have more lead time.'
