Carrie McBane of Sylva was at the end of her rope a year ago. She knew something was wrong and needed to go to a doctor but she didn’t have health insurance. 

There’s a good reason President Lyndon B. Johnson traveled to Independence, Missouri on July 30, 1965, to sign the legislation that created Medicaid — he wanted to present the first membership card to former President Harry S. Truman. 

Truman had long been a backer of socialized medicine, inheriting the position from his Oval Office predecessor Franklin Delano Roosevelt, who established a number of social safety net programs during his 12 years as chief executive.

Calling the $24 billion state budget passed by North Carolina’s Republican-led legislature “an astonishing failure,” Gov. Roy Cooper, D-Rocky Mount, vetoed it June 28. 

North Carolina Gov. Roy Cooper has a budget. The N.C. House of Representatives has a budget. The N.C. Senate has a budget. But as of now, the state of North Carolina does not. 

Four-time freshman legislator and recently re-elected Rep. Joe Sam Queen, D-Waynesville, launched into this year’s legislative session by hosting a trio of town hall meetings across his district, but if the ones held in Jackson and Swain counties were anything like the one in Waynesville on Feb. 16, there’s just one thing on people’s minds — expanding Medicaid. 

Major changes are coming to North Carolina’s Medicaid program, and the regional organizations that manage those dollars for behavioral health needs are wasting no time in getting prepared to respond. 

After wading through more than 300 legislative goals presented by more than 500 commissioners throughout the state, the North Carolina Association of County Commissioners has agreed on five top priorities to present to legislators during the 2015 General Assembly.

Macon County Commissioner Ronnie Beale, president of the NCACC, gave his fellow commissioners an update on the recent Legislative Goals Conference during the board’s retreat last week. 

Hospitals in North Carolina face a catch-22 of the worst kind: the $600 million kind, the kind they have no control over, the kind that involves politics.

Hospitals in North Carolina are seeing a financial hit they can ill-afford after state lawmakers in the General Assembly turned down the federal government’s offer to expand Medicaid last year. It would have added 500,000 uninsured poor to Medicaid rolls.

Republican lawmakers in North Carolina are standing by their controversial decision last year to deny Medicaid expansion to 500,000 low-income people who otherwise lacked health coverage.

Some Democrats in the General Assembly are pushing to revisit Medicaid expansion, however. The legislative season had barely gotten underway last week when a group of Democratic lawmakers introduced a bill that would reverse course on Medicaid expansion.

An elderly man was swindled out of $5,500 by a Department of Social Services employee in Swain County, according to an investigation by the Bryson City police department.

As nursing home bills for his wife mounted, the man had sought help from DSS worker Nicole Warren in hopes of qualifying for Medicaid.

Warren has been charged with three counts of obtaining property under false pretenses and one count of felony conversion, or theft, by the Bryson City Police

Warren had told the man — who wants to stay anonymous and whom authorities refused to name — that he and his wife had too much money in the bank to qualify.

It isn’t uncommon to ask Medicaid applicants with too much money to “spend down” their assets on valid household expenses before they can qualify. In this case, however, Warren proposed some rather unorthodox solutions.

According to Bryson City Det. Sgt. Diane Wike, Warren first asked the man to give her a $3,000 loan. He felt pressured to relent.

“He felt like if he didn’t give her the loan, he might not get the Medicaid for the wife,” said Wike.

Later, Warren asked him to “spend down” a further $2,500. While he proposed making a donation to St. Jude hospital, Warren suggested an alternative charity: the N.C. Social Services Association. She told him to make out a check and she would make sure the organization got it. Instead, Warren tried unsuccessfully to cash it herself, an attempt that was caught on bank surveillance.

Warren went back to the man, insisting that he make the donation in cash instead, according to police reports. The elderly man eventually conceded but demanded a receipt. Warren wrote a handwritten receipt in which she scribbled her name illegibly.

He then asked for an affirmation on letterhead, which Warren wrote using the official DSS letterhead.

“She didn’t sign her name to that one,” said Wike.

Warren also asked for the man to transfer property deeds to her name, but he refused.

The man reported Warren to DSS in late May, and the attorney for DSS in turn reported it to the Bryson City Police Department in mid-June.

Wike said Warren confessed almost instantly.

“Her explanation was that she got in a bind and needed money,” said Wike. “She had a clean record. She’s never been charged with anything.”“

Tammy Cagle, the Swain County DSS director, did not return calls, and Justin Greene, the attorney for Swain County DSS, said that he could not comment on any “ongoing personnel issues or certain issues involving law enforcement.”

Abuse of the elderly

This particular case undoubtedly qualifies as elder abuse, according to Kim Gardner, elder abuse program coordinator for the 30th Judicial District Domestic Violence-Sexual Assault Alliance.

“It’s financial exploitation,” said Gardner. “She used her power and influence to obtain $5,500 from this man fraudulently.”

Gardner suspected the Bryson City Police did not include specific elder abuse charges in Warren’s indictments because its penalties are less severe. There is no mandatory jail time though probation can be given.

“That’s probably why they went with the stronger charges,” said Gardner, adding that she’d like to see the charges changed. “We need more teeth in the elder abuse laws.”

To qualify as elder abuse, the victim must be over 60. Though Gardner warned the elderly to be cautious with their money, she doesn’t think they should be afraid to ask for assistance at DSS.

“I know a lot of people have negative thoughts about DSS from time to time,” said Gardner. “[But this is] an unusual occurrence. They’re there to help people.”