@NCCapitol

@NCCapitol

Latest NC effort to reform Medicaid underway

Posted December 5, 2013

— 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.

Idea of changing Medicaid draws crowd Idea of changing Medicaid draws crowd

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."

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  • whotmewory Dec 9, 2013

    It was wholly inappropriate, ignorant and self-aggrandizing for our new governor to imply that our DHHS employees [who deal with Medcaid fraud] are in part to blame for teachers not getting a raise. It is lame for WRAL and our printed media to ignore the [more seedy] federal mandates and pressures under which our DHHS staffers are forced to work.

  • notexactly Dec 9, 2013

    jackjone

    really dude?? You can sit there and blame the gop for something the dems had 100% in creating? WOW? They have had control for over 100 years. The system has been a wash for ever. The gop had nothing to do with this. Now they have to try to fix it. You must not read much, or get out in the real world. You guys are pathetic. Take no responsibility at all. But that is what you guys stand on so I am not to surprised. Blame others for your failures and put your hand out for help. pretty much sums it up. Question, with obamacare why do we still need Medicaid? All will have insurance right?

  • AliceBToklas Dec 6, 2013

    NC Republicans have demonstrated they cannot be trusted to serve the public.
    --jackjones2nc

    Sadly, the current Medicaid system in this state is the result of 'reform' coming from the Democrats. My spouse works for the people on the receiving end and this has been a disaster. My point is that this crosses party lines.

  • HeadsUp Dec 6, 2013

    Now watch for McCrory campaign contributions from out of state managed care corporations -- which will, of course, be purely coincidental.

  • whatelseisnew Dec 6, 2013

    "Medicaid has been over budget for several years because the GA intentionally underestimates the costs in their budgets. Sort of like knowing you will be driving 2,000 miles per month in your job and budgeting for only 1,800 miles. It's just an excuse to cut somewhere else to make up for a known and planned shortage."

    Baloney. Tell ya what. You tell me within say 500,000 dollars how much money in Medicaid Medical Claims will have to be paid next year. At best they can guess based on historical numbers, factor in increases in costs, and they also need to make an assumption of How many people will be ON Medicaid. Will that number increase or decrease. Given people continue to move here I suspect you have to go with planned increases. On top of all that there is NO WAY to know the type of services that will be needed. Will there be 100000 heart attacks? 5000? and on and on. The variables are enormous.

  • whatelseisnew Dec 6, 2013

    "I am fearful of any plans coming out of this effort. Those in the most need have been neglected for too long. Even those serving this population have been suffering from poor funding and over regulation."

    that is absolutely NONSENSE. In fact, it is the middle class that has been damaged and for many driven into poverty by these insane programs. It is time to rid ourselves of Medicaid and Medicare and Social Security and now of Course ObamaCare. This is nothing more than theft and enslavement put on the backs of those that are trying to do the right thing and see to their own needs. I am tired of being robbed for the so-called POOR and neglected. Stay out of my wallet. States SHOULD HAVE never gotten involved in this miserable foolish Federal Program. But hey greedy dems controlled the decision and they figured they could skim money off the top of the Medicaid dollars that are looted from peoples paychecks.

  • jackjones2nc Dec 6, 2013

    NC Republicans have demonstrated they cannot be trusted to serve the public.

  • AliceBToklas Dec 6, 2013

    I am fearful of any plans coming out of this effort. Those in the most need have been neglected for too long. Even those serving this population have been suffering from poor funding and over regulation.

  • free2bme Dec 6, 2013

    More wasted tax dollars by McCrory. He will be gone before there is any good change to Medicaid. McCrory and his over paid campaign workers are destroying this state. DHHS needs to clean house then maybe we will see some decent progress.

  • miseem Dec 5, 2013

    Medicaid has been over budget for several years because the GA intentionally underestimates the costs in their budgets. Sort of like knowing you will be driving 2,000 miles per month in your job and budgeting for only 1,800 miles. It's just an excuse to cut somewhere else to make up for a known and planned shortage.