NC Medicaid Proposal Would Shift Care To Regional Plans

Dec 5, 2013

The state’s Medicaid Reform Advisory Committee (from left, Sen. Louis Pate, Dr. Richard Gilbert, Dennis Barry, Peggy Terhune, Rep. Nelson Dollar
Credit Jorge Valencia
  The North Carolina health department may create up to seven regional networks across the state to give Medicaid services, instead of allowing companies to compete to provide government insurance statewide, according to a new proposal.

 Under the regional networks, case managers would be assigned to each state resident who receives Medicaid benefits, said Bob Atlas, a consultant the Department of Health and Social Services hired this year to analyze Medicaid reform options. A portion of the 1.7 million currently receiving benefits have case managers. 

 “The primary motivation for regions is to allow providers on the ground who don’t generally have statewide networks in place today to be able to have a better chance at organizing networks that can participate in the program without having to fulfill a statewide mandate,” Atlas said. 

 Atlas and four state health managers presented their assessments of the state’s Medicaid program on Thursday to a five-person committee Gov. Pat McCrory created this year to create a proposal on how to overhaul the program. It was the group’s first meeting. 

 Two committee members, Rep. Nelson Dollar (R-Wake County) and Peggy Terhune, director of the Albermale-based mental health nonprofit Monarch, expressed skepticism about the need to set up regional networks. Atlas said he wanted to show “we’re on a path,” and that the proposal was the beginning of a conversation. 

   Gov. Pat McCrory and Department of Health and Human Services Secretary Aldona Wos have made reforming the state’s Medicaid system a priority since a report released by the state auditor in January showed the cost of delivering services in North Carolina is “significantly higher” than in states with similarly sized programs. McCrory has said he wants to reduce administrative costs to create an economically sustainable model for Medicaid.  

 This is the second time this year the health department has made an effort to present a healthcare overhaul proposal. The committee is scheduled to meet in January and February and present a plan to law makers in March. Other members include chairman Dennis Barry, former CEO of a Greensboro-based hospital system; Dr. Richard Gilbert, chief of staff for Charlotte-based Carolina’s Medical Center; and state Sen. Louis Pate (R-Wayne County).