Medicaid muddle
Published July 13, 2014
Editorial by Greensboro News-Record, July 13, 2014.
Medicaid is too important and expensive not to get right.
North Carolina leaders are set to make changes in Medicaid delivery — but they don’t agree among themselves, creating confusion and uncertainty about the future of the $13 billion program.
The News & Observer of Raleigh recently published a series of articles detailing problems, including a rapid increase in state spending and administrative disarray. There was some good news. Medical costs per patient have declined since 2008 and a higher percentage of providers treat Medicaid patients than the national average. Overall costs are rising, however, because more people became eligible for coverage during the recession.Medicaid serves people who usually don’t have other options than seeking treatment in emergency rooms, where they couldn’t pay the bill. The better approach is to put them on a schedule of preventive care and routine treatment, keeping them healthier and holding down long-term costs.
North Carolina traditionally has used broader eligibility standards than most states for the purpose of drawing more federal dollars and increasing support for the medical industry here.
The state’s new Republican leadership is taking a different approach. It turned down Medicaid expansion under Obamacare, despite the promise of full federal funding for three years, believing it would cost the state too much later. The state Senate wants to tighten eligibility, which would remove coverage for thousands of patients. Gov. Pat McCrory also declared that the state’s Medicaid system was “broken,” preventing its ability to serve more patients. He’s backed away from using that term lately, The N&O reported, saying instead that “the system is not sustainable for the long run.”
To improve it, he and leaders in the state House of Representatives want to create a network of accountable care organizations that manage patients’ care and assume increasing responsibility for costs and outcomes. This is similar to Community Care of North Carolina, which already manages most of the state’s Medicaid patients. Hospitals and doctors support this model as preferable to many alternatives, including a Senate proposal that would pay private managed-care companies to supervise patient care, with oversight by a new state Medicaid agency.
The Senate shows little confidence in the state Department of Health and Human Services, which currently operates the Medicaid program. Turnover in top positions, reliance on contractors who lack appropriate experience and poorly functioning computer systems have added to costs and hampered service delivery. Tracking of expenditures has become so spotty that legislative leaders don’t trust cost estimates and enrollment figures.
Troubles also existed under Democratic governors while Democrats led the legislature. Medicaid is McCrory’s problem now. He needs to improve DHHS administration and lead the legislature to common ground. Medicaid must provide quality care at sustainable costs for those who truly need it. Getting it right is essential for maintaining a healthy population and financially sound state government.
July 13, 2014 at 6:22 pm
Richard Bunce says:
Change to a system like Arkansas and I believe a few other States are moving toward... Place all Medicaid eligibles into the ACA Marketplace where they will have their premium covered by pre-refundable tax credits and some help through tax deductions for deductibles and co-pays. They will not have nearly the problem of finding a provider since many providers do not accept Medicaid.
