While most of North Carolina is  either on vacation or preparing for it, the Republican-led General Assembly is hard at work. I say kudos to North Carolina’s fiscal reformers who are taking “governing” very, very seriously. It would be easy and politically expedient to put off difficult negotiations and decisions that Democratic-led legislatures kicked down the road. For three-plus years, the reformers have made methodical steps that are turning this state around. I am truly thankful. Here’s where we stand on key fiscal negotiations, as reported by Carolina Journal’s Dan Way.

The conferees agreed to include nearly $137 million in the 2014-15 budget to cover an anticipated Medicaid shortfall still being calculated from the 2013-14 budget. The Senate clipped nearly $13.5 million from its earlier $150 million offer. The House added nearly $61.3 million to its earlier offer of $75.2 million.

On the Medicaid rebase — the adjusted number accounting for program growth and other costs in the second year of a two-year budget cycle — the two sides agreed on nearly $186.4 million.

To get there, the Senate cut almost $42 million from its $228.3 million projection. The House added nearly $68.6 million to its $117.8 million forecast.

Still looming is a battle on structural reforms to Medicaid. Gov. Pat McCrory praised the House Wednesday for passing House Bill 1181, the North Carolina Medicaid Modernization Act, and urged the Senate to approve it as well.

The plan would be phased in using an Accountable Care Organization model. DHHS would lead the gradual switch from a fee-for-service system to a capitated plan making health care providers more responsible for cost overruns.

The Senate wants to carve Medicaid out of DHHS, and prefers a managed care system to fee-for-service.