WRAL Investigates

Wake agency pushes Medicaid: 'We want them to stay on'

Posted August 20, 2012 6:00 p.m. EDT
Updated August 21, 2012 9:02 a.m. EDT

WRAL Investigates

— North Carolina spends $12 billion each year in federal Medicaid money, which provides everything from pregnancy care to counseling for low-income residents. In the midst of government cuts, the WRAL Investigates team found Wake County Human Services staff making a push to increase the Medicaid rolls.

Wake County held training for human services staff last week, which WRAL Investigates attended, and the directive was clear – everyone in the agency should identify people in the community who are eligible for the low-income government insurance. The training will continue sporadically over the next few weeks.

“We want them to get on Medicaid. We want them to stay on,” said Medicaid trainer Betsy Moore. “We see this as a benefit to the client and, in turn, it is a benefit for us.”

A training memo stated that Medicaid is everybody's business and encouraged staff to help increase the agency’s revenue.

“We’re just wanting our staff to have the conversation,” said Liz Scott, Medicaid program manager for Wake County Human Services. “They may be the only person from our agency that's interacting with that client.”

Scott says the new push to enroll eligible people is twofold. First, insurance coverage can help get low-income clients on a healthier road that includes a primary care physician and preventive medical treatment.

“Part of the focus is not just to enroll people in Medicaid, but also to educate clients on having a medical home,” she said.

Second, it can bring more money into the agency. “There is the potential to lose revenue, and so, this is a strategy,” Scott said.

The reason, Scott says, is because the state has started shifting from a "fee for service" system, where Medicaid reimburses providers for every visit, to what is called a "per member per month" plan.

Wake County Human Services officials say the funding change could result in a $1 million Medicaid revenue loss per year for the agency. Leaders hope that adding eligible clients to the government insurance plan will recoup about half of that potential cut.

Fiscal YearWake Human Services BudgetWake Human Services Medicaid Revenue

Currently, mental health, child services and pregnancy care are transitioning to the more managed care system. The goal is to create a medical home with a continuity of care. The pregnancy program, for instance, is producing healthier mothers and babies at reduced costs, according to Scott.

There's also incentive for providers. The more people registered with Medicaid, the more revenue flows to places such as Wake Human Services to provide care.

“Our interest is, we want anyone who is Medicaid eligible, we want to make sure they are connected to a primary care physician and that we are really managing their health care and managing those very scarce taxpayer dollars,” said Rep. Nelson Dollar, R-Wake, who chairs the House Appropriations Committee on Health and Human Services.

The legislator says Wake County's effort to reach out to clients makes sense. He acknowledges it will increase the Medicaid rolls, but says as long as fraud is weeded out fewer dollars will be spent.

“We would rather have them in the system and have their health care properly managed, than to have people simply flooding into the emergency room,” Dollar said.