Under the Dome podcast: NC’s DHHS secretary on Medicaid expansion, COVID and the budget

It’s three months late, but today is the day for the long-awaited North Carolina state budget to become law.

Dawn Vaughan here, The News & Observer’s Capitol bureau chief and host of Under the Dome. Along with the budget comes Medicaid expansion. So our guest for this week’s episode of the Under the Dome podcast for Oct. 2, 2023, is the man leading the major health care change.

I talked with N.C. Department of Health and Human Services Secretary Kody Kinsley in his office in the Adams Building on the DHHS campus at Dix Park last week. Earlier that day he joined Democratic Gov. Roy Cooper to announce Medicaid expansion would launch Dec. 1. He also got his COVID-19 and flu vaccinations that day.

Here are some highlights of our conversation, and you can listen to more of what he said on the podcast.

Why a Dec. 1 Medicaid expansion start date?

Cooper said he’d let the budget become law without his signature after 10 days. Kinsley said he is grateful to Cooper as well as some Republican lawmakers who supported expansion before it was popular, like Labor Commissioner and former state Rep. Josh Dobson, and Rep. Donny Lambeth of Winston-Salem, one of the top Republican budget writers.

Kinsley noted the Medicaid expansion bill signing in March was preceded by a bout of bad weather, “and then the spring skies parted and it was beautiful out. And then we similarly had a deluge of rain over the weekend and here you are in Dix Park, and it’s gorgeous out again. So I’m deciding that Medicaid expansion is related to that. My meteorologist friends may disagree,” Kinsley said.

So if the budget is law after Oct. 2, why is Dec. 1 the Medicaid expansion start date?

Listen to Kinsley explain what has to happen to get it rolling. He said DHHS wants to “try to make this as streamlined and coordinated as possible.”

“So this gives us a good amount of time to communicate — but look, this is also record speed. If you look at a lot of other states that have gone live on expansion, it’s it’s a six-month process sometimes. So the fact that we are so prepared is why we’re able to pull this off so fast,” he said.

DHHS raises and health funding in the budget

A big part of this budget, and every budget, is raises for state employees. Kinsley told me that recent DHHS data shows that employee turnover is slowing down and recruitment is up.

“I think that parallels with the overall slowdown of some of the job aspects of the economy, and people are not changing jobs as frequently. But yeah, we’re running a relay race at the department and every fourth person is missing. And with a near 25% vacancy rate, it’s ... just really challenging to offer the critical life saving services that we offer to the people in North Carolina every day,” he said.

Kinsley said that he’s grateful for the 7% raises over two years and about $20 million for retention incentives for health care facility employees, but would have preferred to see raises more on par with the market.

The DHHS secretary said that while Medicaid expansion is huge, earlier this year his agency put out “a billion dollar investment roadmap for behavioral health in North Carolina, and this budget gave us $700 million of that.”

Kinsley goes on to list other major health priorities funded in the budget, including foster care.

COVID this fall

Kinsley encourages people to get their COVID-19 booster shot this fall and to have rapid tests at home. For those who are sick, there are drugs readily available and effective for the vast majority of North Carolinians, he said.

“The great news is that we have the tools to manage COVID so it doesn’t manage us, and we’re thinking about COVID all across the country in the same way that we think about other respiratory illnesses. We’re obviously still kind of solidifying what will be the probably annual schedule of COVID boosters, but it’s great that right now we have one available,” Kinsley said.

The feds and Headliner of the Week

After the break, I’m joined by our Washington correspondent, Danielle Battaglia. She shares the latest on the federal government shutdown and the Senate dress code. And stay tuned for our picks for Headliner of the Week.

Listen to our latest episode below and catch up on previous episodes. You can also listen on Apple Podcasts, Spotify, Google Podcasts, Audible, iHeart, Pandora, Amazon Music and Stitcher.

Now you can also watch video of our Under the Dome podcast on our N&O YouTube page.