Providers fret over N.C.’s move to Medicaid managed care
North Carolina hospitals and doctors say the state’s push to institute Medicaid managed care will reduce services for the poor and shortchange providers despite the legislation giving them the opportunity to bid on the contracts.
Late last month, Republican Gov. Pat McCrory signed legislation enabling changes that will move the state’s $12.7 billion Medicaid program serving 1.9 million residents from fee-for-service payments made directly to providers to capped payments to managed-care insurers. The state must get CMS approval before making the change.
The legislation allows the state to award three statewide managedcare contracts to insurers. It also authorizes the creation of as many as 12 regional “provider-led” entities—physicians and hospitals in a Medicaid accountable care organization, for instance—that can sign agreements with the state to manage Medicaid populations.
“Under the current system, we wait until people get sick to provide care and pay for tests— not outcomes,” McCrory said.
Providers backed changing the program, but rejected turning to private insurers as the main vehicle for cost control. “We’re concerned about the draconian ways (that plans) try to control things,” said Robert Seligson, CEO of the North Carolina Medical Society. “Instead of a value-based medicine approach, they focus on financial returns. Wall Street is what drives them.”
“It’s not what we wanted,” said Julie Henry, a spokeswoman for the North Carolina Hospital Association. “We wanted an exclusively provider-led system, because from our perspective hospitals are already bearing the financial risk for Medicaid patients.”
The state plans to submit its waiver application to the CMS by next summer.
North Carolina Gov. Pat McCrory
signs Medicaid reform legislation.