State lawmakers last week moved closer to agreement on a plan for revamping the state’s Medicaid system.
But the plan that is shaping up through informal negotiations appears as if it will further complicate an already complex program.
The N.C. House voted Wednesday to reject the N.C. Senate’s plan to overhaul Medicaid, setting up negotiations between the two chambers to forge a compromise version of their competing plans.
The Senate’s plan would contract out the system to private managed-care and insurance companies, while the House plan would have the state enter into those contracts with in-state hospital and doctor medical networks.
House and Senate Republican leaders announced Thursday they are working toward a compromise proposal in which private companies and medical networks would compete for those contracts.
This announcement came as N.C. State Auditor Beth Wood released an audit of Community Care of North Carolina, the nonprofit managed-care program in which regional doctor networks and local case managers oversee the medical care of 1.4 million North Carolinians on Medicaid. The audit found that Community Care saved the state an average of $312 per patient per year – or about 9 percent of state spending on Medicaid. The audit also found evidence that Community Care’s oversight contributed to improved health outcomes of Medicaid recipients, such as a 25 percent reduction in inpatient hospital admissions.
But lawmakers are intent to dismantle Community Care, the Senate as soon as next spring and the House once the private companies and medical networks are ready to manage the system.
Many states that turned to private managed-care companies to run their Medicaid programs have seen these companies delay or deny medical care in order to cut costs and increase profits. And the idea that regional medical networks will be able to compete with billion-dollar managed care and insurance corporations for state Medicaid contracts is dubious at best.
House Republicans’ decision to split the difference with their Senate counterparts by agreeing to let both private companies and medical networks vie for state Medicaid contracts was a mistake – and one that could prove not only costly for state coffers, but detrimental to the health and quality of life of Medicaid patients.
