Senate moves ahead on Medicaid restructuring

Posted July 17, 2014

N.C. health, mental health, Medicaid generic

— Despite a chorus of protests, including the governor's, Senate leaders are moving ahead with a plan to restructure the state's Medicaid system.

The Senate plan, introduced Wednesday, would turn the state's Medicaid system over to non-state management - either managed care or provider-led accountable care organizations - which would accept a flat amount per patient in return for providing all of the behavioral, physical, specialized and other care for that patient. 

Senate leaders said the so-called "capitated" plan would bring state Medicaid spending under control. But critics say the Senate proposal would send administrative dollars out of state to large commercial insurance networks, cut physician participation and dismantle the state's award-winning behavioral health network, Community Care of North Carolina.

At Thursday's hearing on House Bill 1181, only one person spoke in favor of it: Jeff Myers, representing the trade association of insurance plans that manage Medicaid care in 34 other states. He assured the panel that managed care delivers not only lower cost per patient but better care and better overall outcomes. 

Greg Griggs, representing the North Carolina Academy of Family Physicians, disagreed, warning that forcing small practices to juggle the requirements of multiple private Medicaid management contractors would "bury" those doctors in a mountain of paperwork. 

In North Carolina, Griggs said, 90 percent of primary care doctors accept Medicaid patients. In Florida, which is the model for the Senate proposal, about half of them do. He said the academy supports the reform plan backed by the House and Gov. Pat McCrory. 

Mary Hooper, appearing on behalf of the state's current managed care system for behavioral health, warned that the Senate plan would "destabilize" that system.

"They are an example of successful public behavioral managed care. We respectfully request that you not take that system apart,” Hooper said.

Pam Kilpatrick with the Office of State Budget and Management advised the panel that the proposal's timeline for the near-immediate creation of a new Medicaid department outside the Department of Health and Human Services would be difficult to meet.

"Medicaid is complex," Kilpatrick said. "We would hope there could be time to plan a transition." 

DHHS legislative liaison Adam Sholar spoke against taking Medicaid out of the agency, saying it would not serve the best interest of recipients of services. He also warned that putting an executive branch function under a board largely appointed by lawmakers violates the separation of powers, a constitutional issue that would be "ripe to a challenge in the future that could hamper the operation of the program.” 

Ardis Watkins, legislative affairs director for the State Employees Association of North Carolina, also spoke against the bill, noting, as others did, the 16 months of work that has already gone into the Medicaid reform effort at DHHS.

"It feels like things are getting pushed through at the 11th hour that would turn all that on its head," Watkins said. 

On Wednesday afternoon, McCrory also issued a statement of opposition to the measure.  

Senate leaders were unmoved by the protests.

"We have listened to everyone," said bill sponsor Sen. Louis Pate, R-Wayne. “I think it’s time to move on and get this procedure over with.”

“I look forward to this being completed in the short session,” said Sen. Ralph Hise, R-Mitchell.

 The Senate is expected to vote on the measure early next week.


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  • Wake1 Jul 18, 2014

    Ever wonder why the Medicaid program has to be such a complicated program with so much waste??

  • WRAL_USER Jul 18, 2014

    "We have listened to everyone," said bill sponsor Sen. Louis Pate, R-Wayne.

    Everyone who is a managed care corporation AND political donor...

    Mr. Pate, we are listening as well....

  • miseem Jul 18, 2014

    View quoted thread

    Can you cite any source that documents real savings, or just cooked figures that hide denial of services to a group that typically cannot fight against a corporation's decisions. As some others have mentioned, the NCGA, par for the course, has a predetermined agenda hatched by ALEC. Hearings are just window dressing to satisfy legal requirements. One person spoke for this, numerous others against. And the one speaking for the proposal will make millions off of the legislation.

  • teleman60 Jul 18, 2014

    A list of all the states opting for managed care in one column, then all states with republican legislatures, then all states Medicaid total payouts, THEN CAMPAIGN CONTRIBUTIONS FROM MANAGED CARE CORPORATIONS TO POLITICIANS.

    My feeling is that there are a lot of ways to make mega bucks today BUT HEALTHCARE AND DRUGS shouldn't be on the list and they aren't in many countries EXCEPT AMERICA.

    I wish we could force Americans to look at the facts NOT LISTEN TO POLITICIANS. The facts show the U.S. WAY DOWN THE LIST as far as healthcare outcomes per dollar spent. We spend the most IN THE WORLD for only marginal results. WHY????? Because all those pesky FOR PROFIT CORPS running hospitals, pharma/drug companies, medical supplies. A LARGE portion make ALL THEIR MONEY over charging Medicare and Medicaid.

    These companies ENGINEER their whole business to rob the government healthcare system.

    Any person presented with the facts is sure to be angered and embarrassed at tax dollars wasted.

  • Holly Atkins Jul 18, 2014
    user avatar

    So Jeff Myers is the only one NOT in CCNC's pocket! Making doctors accountable AND not throwing money down a sinkhole is a great idea!

    Community Care started as a PROJECT under DHHS and guess who ran it? You got it! DHHS! If you ever look at the Executive staff of CCNC you'll notice that MOST were Exectuive staff of DMA. Dr. Dobson was DMA Director, Tork Wade worked as Director of Rural Health Development, Mark Benton was Director of DMA and I could go on.

    This isn't sound Medicaid savings, it's rewarding political cronies! Get rid of CCNC and keep the networks. They're the ones that do the work!

  • bill0 Jul 18, 2014

    "If people had the taxes taken from their paychecks to actually cover the costs of programs like Medicaid, Medicare and Social Security... they would DEMAND reforms like this"

    Wow! Just when I thought you couldn't be more wrong. Every working american has nice little line item on their paycheck detailing this already.

    There is nothing new here. We are talking about HMO's. That's it. They've been around for 40 years and dominate the private insurance market. If you've ever pulled your hair out dealing with all the red tape of an insurance claim, you'll recognize how "efficient" they are. It wouldn't be the end of the world for medicare/medicaid to be managed that way, but it isn't some magical new solution. They don't make treatments cheaper, they just limit services. If obama was promoting this, the GOP would be yelling "Death Panels" right about now.

  • teleman60 Jul 18, 2014

    Once again Tillis leads the pack trying to insert insurance corporations into the mix that 90% of doctors and patients DON'T WANT!!! But them there corp campaign contributors of Tillis's will chuckle and take the money!

    Just because other states do something doesn't make it right.

    Look at Kansas - There republicans are backing THE DEMOCRAT in the election because their current tea party governor's taxcuts have bankrupted the state causing credit downgrades and hundred million dollar revenue shortfalls - SOUND FAMILIAR NORTH CAROLINA VOTERS? - ARE YOU LISTENING??? It's already happening here.

  • Maurice Pentico Jr. Jul 17, 2014
    user avatar

    View quoted thread

    YES... 34 other States are saving money!
    Why shouldnt NC?

  • Matt Wood Jul 17, 2014
    user avatar

    "We have listened to everyone," said bill sponsor Sen. Louis Pate, R-Wayne.

    Apparently you've only listened to one person:

    "At Thursday's hearing on House Bill 1181, only one person spoke in favor of it: Jeff Myers, representing the trade association of insurance plans that manage Medicaid care in 34 other states."


  • Anita Woody Jul 17, 2014

    I'd like to see a report on the Senate bill to allow the police to track license plates with the highway and local traffic cameras.