Associated Press October 23, 2019
Skepticism grew on Wednesday that a massive change in administering North Carolina Medicaid's
program will start as scheduled early next year as a state budget
stalemate continues and doctors and hospitals worry whether details are ready.
The shift to managed care benefits for 1.6
million of the state's 2.2 million Medicaid recipients is supposed to begin
Feb. 1, but final funding and details are hung up in a legislative showdown between Republican legislators
and Democratic Gov. Roy Cooper. One rollout date for covering patients in
one-quarter of the state's counties — previously set for Nov. 1 — already has
been pushed back to the statewide date.
Speaking to House members during a hearing,
Department of Health and Human Services Secretary Mandy Cohen expressed
optimism that the "right budget" could still be hammered out before
mid-November, which she describes as the deadline to go online in February.
"I know that there is a package there that
can work for everyone," Cohen told the House Health Committee.
But a key Republican lawmaker on healthcare
matters said a budget agreement was unlikely and suggested the start be pushed
to next summer.
"I would advocate for some realistic review
of this schedule and even considering pushing this off until July 1," Rep.
Donny Lambeth of Forsyth County, the committee's co-chairman, told Cohen.
"I just don't see that that's a realistic timeline with where we are
today. And I know you don't want to do that. I know there's consequences of
delays."
Rep. Verla Insko of Orange County, the
Democrats' leading expert on Medicaid, said pushing back the rollout also
sounded reasonable.
A lot is riding on the move, which Cohen called
the biggest change to North Carolina Medicaid since it began decades ago.
Failure would reflect poorly on both Cooper and GOP legislators, which kicked
off the transition with a 2015 law.
Medicaid is moving from a traditional
fee-for-service model to one in which four private insurers and a physicians'
partnership awarded contracts by the state will receive fixed monthly payments
for every patient seen. Health officials say the changes should lead to
improved health outcomes and more fiscal stability for Medicaid, which spends
about $4 billion in state tax dollars annually. The federal government covers an
additional $12 billion.
The shift is a monumental effort that includes
enrolling Medicaid recipients, setting payment rates, building and testing
information technology systems and preparing counties who enroll beneficiaries
and providers who treat them.
"This is really years of work in the
making," Cohen said. "This is big and this is hard."
So far about 70,000 enrollees have chosen one of
the statewide or regional coverage plans, and about 40% of the doctors who have
seen at least one Medicaid patient over the past year have entered into service
contracts, said Dave Richard, the state's Medicaid director.
The potential delay surfaced when the governor
vetoed the overall two-year budget bill in June that contained the transition
funds to complete "Medicaid transformation." He cited in part the
lack of Medicaid enrollment for hundreds of thousands of additional adults
through the 2010 federal health care law.
Republicans are largely opposed to this Medicaid
expansion, but they also lack veto-proof majorities in both chambers. Their
disinterest in negotiations involving expansion contributed to the four-month
impasse. GOP legislators approved a stand-alone bill in August addressing only
the managed-care matters, but Cooper vetoed that too, saying health care needed
to be addressed "comprehensively."
Cohen said any agreement also needs to ensure
that $42 million in administrative cuts to DHHS in the vetoed budget are
restored and that the department isn't forced to move out of Raleigh. The
budget law had directed DHHS move its headquarters to Granville County.
Even should an agreement be reached in the next
three weeks, representatives of trade groups for the state's hospitals and
physicians raised warning flags about whether colleagues will be prepared by
February for the exponentially complicated process.
"We're trying to guard against any kind of
failure," said Chip Baggett, a vice president at the North Carolina
Medical Society.
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