Long-term Medicaid reform discussion could move to special legislative session

With a budget deal all but inked Tuesday, lawmakers have set their sights on adjourning their summer session by Saturday. Already, they have lingered in Raleigh a month longer than planned. 

While the $21.3 billion budget is the biggest item left on lawmakers' to-do list, it is not the only one. Measures dealing with managing the cleanup of coal ash ponds across the state, streamlining regulations and economic development remain on the table. 

That leaves little legislative bandwidth for Medicaid reform, a topic where House and Senate leaders vary markedly in their approaches.

The plan passed by the House would give local doctors and hospitals incentives to create accountable care organizations, which would take care of Medicaid patients for a set fee. The plan Senators returned to the House would look to out-of-state managed care companies to care for the state's Medicaid population. Senators have also pushed to restructure Medicaid, moving it from the Department of Health and Human Services into a new state agency. 

Gov. Pat McCrory has backed the House proposal, which resembles his own Medicaid reform plan, and has objected strenuously to the restructuring elements of the Senate plan. 

Either approach would represent a major restructuring of one of the costliest programs in state government.  

"There is not a lot of time before the end of session to deal with the issue before the end of the week," Rep. Nelson Dollar, R-Wake, said.

Dollar was the lead author of the House's Medicaid proposal. He would not speculate about the possibility of a special session but said it was unlikely there was enough time left to forge a deal on Medicaid before Saturday. 

Sen. Harry Brown, R-Onslow, the Senate's lead budget writer, said lawmakers would ideally push to cut a Medicaid deal by the end of the week but agreed that it would be tough to get it done. 

"That's going to be debated the rest of this week," Brown said of the possibility that Medicaid would be left for a special session.

Asked if lawmakers would wait until the 2015 legislative session to take up Medicaid if a deal couldn't be reached by Saturday, Brown said that long of a wait was unlikely.

"I think sooner is better than later," he said.

Other lawmakers, legislative staff and lobbyists who deal with the issue say there has been talk this week of a special session on Medicaid. Such as session would have the virtue of allowing lawmakers to focus on the complex overhaul without the push and pull of other work.

Those familiar with discussions say that, while nothing has been settled, dates shortly after Election Day in November were being discussed.