North Carolina's Medicaid director leaving post

Carol Steckel will leave her post as director of North Carolina's Medicaid program effective Oct. 11. She plans to take a job with WellCare Health Plans of Tampa, Fla.

Posted 6:43 p.m. Sep 23, 2013 — Updated 10:25 p.m. Sep 23, 2013

Mark Binker

RALEIGH, N.C. — Carol Steckel is leaving her post as head of the state's Medicaid program after less than nine months on the job.

Gov. Pat McCrory hired Steckel, who had the same job in Louisiana, and before that Alabama, to run what he has consistently described as a "broken" Medicaid program. Now, it appears his chief mechanic of one of the state's most expensive and troubled programs is about to leave the state.

By way of a news release, Steckel says she has accepted a position with WellCare Health Plans in Tampa, Fla. Her last day will be "no later than" Oct. 11. She reported to Health and Human Services Secretary Aldona Wos.

"It was a difficult decision to leave DHHS, but this is a great opportunity I can't turn down," Steckel said in a statement. "In just a short time together, we have made good progress on reforming the state's Medicaid program to control costs and improve care. I thank the secretary for her leadership and am committed to making this a smooth transition."

Steckel did not respond to a phone message at her office on Monday. Ricky Diaz, a spokesman for the department, declined to make Steckel available for interviews or further comment on her departure. He did say via email that Steckel was the not the subject of any sort of severance agreement.

Wos said that Steckel has made "invaluable contributions to the state and the people we serve." She added, "We appreciate her commitment to a smooth transition as we progress towards creating a predictable and sustainable Medicaid system for the people of North Carolina."

In addition to leaving as the chronically troubled Medicaid system is still fighting through a particularly troubled patch, Steckel's departure comes as McCrory has talked up a sweeping reform of the joint federal-state health insurance program for the poor and disabled.

"She was the one with the policy chops driving that," said Don Taylor, a public policy professor at Duke University. "This is going to blowtorch that (reform effort) as well."

Pushing for managed care

Medicaid covers roughly 1.6 million of North Carolina's 9 million residents. The bulk of those served are children or the parents of children from low-income families, along with pregnant women, the elderly and disabled. The lion's share of the $14 billion cost for the program comes from the federal government, but overruns in North Carolina's smaller share have eaten up savings found elsewhere in the state budget over the past decade.

In Louisiana, Steckel helped remake the Medicaid system, turning much of the service provision over to private companies as part of a managed care model. This year, she helped lead a push for North Carolina to adopt a similar model, but the idea was not received warmly by lawmakers.

Among the businesses that Steckel's new employer, WellCare Health Plans, has is running Medicaid managed care systems in eight states, including Florida and South Carolina. In 2012, the company paid $217.5 million to settle civil fraud allegations with the U.S. Justice Department related to those plans.

"We have to explore more than just commercial managed care," said Rep. Nelson Dollar, R-Wake, a senior budget writer in the House.

DHHS generally and Medicaid specifically have been the subject of tough scrutiny lately, both for high-dollar salaries given to politically connected individuals and a pair of troubled computer systems meant to pay Medicaid health care providers and allow benefit recipients apply for food stamps and other services. That second system, NC FAST, will be the computer network that allows people to apply for health insurance through the federal Affordable Care Act exchanges.

Lawmakers said they were surprised by the departure news Monday.

"We've had some good rapport with her," said Sen. Louis Pate, R-Wayne.

Leaving before computer issues repaired

Pate said Monday afternoon that DHHS staff had been briefing members of the General Assembly on problems with NC FAST and its sister system, NCTracks. Pate said those staff members were promising that the majority of problems with the two systems would be worked out soon.

Problems with NCTracks have prompted a number of providers to complain they have not been paid for services provided to Medicaid beneficiaries. Steckel will apparently leave the department before those problems are fully ironed out.

However, neither Pate nor Dollar treated Steckel's departure as a setback for the agency.

"DHHS always has challenges with reorganization. … Personnel come and go," Dollar said.

Steckel's departure, he said, gives the state "an opportunity to have a restart on Medicaid reform. We want to get it right." DHHS, he said, now can look for someone "who can mesh a little better, create a closer relationship with the General Assembly."

But Taylor said that Steckel's loss will be keenly felt. She had already run two other state Medicaid systems, as well as a state association of Medicaid directors. It will be hard, he said, to attract someone with the same experience.

"We've lost someone who is really experienced," he said.

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