Raleigh, N.C. — The state Department of Health and Human Services wants some help reshaping the Medicaid program so it operates more efficiently.
"Medicaid Director Carol Steckel and I are committed to transforming the operations of the Division of Medical Assistance through innovation and reform," DHHS Secretary Aldona Wos said in a Monday letter accompanying a request for information. "We strongly believe that we must prove to the residents of North Carolina that the program can not only provide high-quality access to health care services to our recipients, but also manage the tax dollars entrusted to us in a better, more efficient way."
A state audit released last week showed that North Carolina spends 38 percent more to administer its Medicaid program than eight other states with similar-sized programs. The higher costs translate into an extra $180 million in North Carolina.
State Auditor Beth Wood attributed the problems to Inefficient management, lax oversight of contracts, a lack of budget forecasting and, in some cases, outright flouting of state law.
Wos said the RFI is a way to gather as many suggestions as quickly as possible. She wants submissions by March 15.
"We encourage bold recommendations. We also encourage recommendations that are both comprehensive in nature or address only one area of service, such as long-term care," she said.
DHHS wants suggestions that meet the following guidelines:
- They are market-based and utilize community-based providers.
- They enhance recipients’ personal responsibility both for financial participation and health care decisions.
- They assess the optimal level of benefits to meet the health care needs of Medicaid recipients.
- They provide short-term savings and a sustainable, predictable Medicaid program for the future.
- They create payment policies with incentives to provide the right level of care at the right location.
- They use accepted and verifiable financial measures to evaluate and assess the program's efficiency and metrics to ensure appropriate levels of care and service.
- They address the need for coordination between physical health and behavioral health.
- They focus on improving the health of North Carolina citizens and lawful residents.