Raleigh, N.C. — Months after Gov. Pat McCrory declared the state Medicaid system as "broken," a five-member panel charged with coming up with repair ideas met for the first time Thursday.
The Medicaid Reform Advisory Group, led by former Cone Health Chief Executive Dennis Barry, attracted the attention of a standing-room only crowd of health care providers and lobbyists to the Dorothea Dix campus as it tries to address problems that range from annual cost overruns to tardy payment of providers.
The health care system for about 1.6 million poor and disabled people in North Carolina accounts for about $13 billion in state and federal spending, and McCrory and Republican legislative leaders have blamed out-of-control costs for not providing teachers and state workers with a raise this year.
Reform means re-evaluating which Medicaid services should be provided, who should be eligible and how to consolidate the divide between mental and medical care.
"How are we going to do this? How is it going to affect the consumer? How does it affect the state? How does it affect the provider?" asked Lou Wilson, a long-term care provider.
"We need to look at who is eligible – Are we above what is required for eligibility? – but also looking at our programs and services, not to eliminate (anyone), but what is the most cost-effective way to add to the value-added proposition," said Sandy Terrell, acting Medicaid director.
"Care coordination is a very important part of tomorrow's system," Barry said.
The panel will examine what's working in other states, but a major question to be explored is how far the state will wade into managed care run by private companies.
In April, McCrory floated the idea of using private providers to offer more comprehensive care, improved customer service and a more predictable cost structure for the state, but lawmakers have appeared cool to the idea.
Panel member Rep. Nelson Dollar said Thursday that he wants to improve the existing Medicaid system, not scrap it.
"The problems that we've seen in the past several years have been more toward the management of the program within state government," said Dollar, R-Wake.
"They need to be geared to the patients. We need to make sure the quality of care is there before we just start cutting dollars," pharmacist Mike James said.
The panel, which also includes Sen. Louis Pate, R-Wayne, and Dr. Richard Gilbert, chief of staff at Carolinas Medical Center in Charlotte, hopes to have recommendations to lawmakers before the 2014 legislative session starts in May.
But with the limited number of meetings in the coming months – a public hearing is scheduled for Jan. 15 – and the size and number of problems facing Medicaid, panel member Peggy Terhune tried to temper people's expectations.
"We'll be able to do kind of some overarching principles," said Terhune, the chief executive of Monarch, a Stanly County provider of services to people with developmental disabilities and mental illness. "It's not like we can solve all the world's problems."