Source: Orr, Adam (2015, August 9). Is big shift on the way for Medicaid in NC?
The Gaston Gazette. Retrieved from www.gastongazette.com.
The head of CaroMont Health can’t be much clearer about his vision
for the future of the state’s Medicaid system.
“We can make some large-scale changes to the system” CaroMont
Health CEO Doug Luckett said. “But managed care ain’t it.”
That was Luckett’s message to state lawmakers considering big changes
to state’s Medicaid system. Tens of thousands of low-income residents
in Gaston and Lincoln counties currently look to the system for their
Statewide, that number climbs to more than 1.8 million people.
In an effort to trim some of those costs and simplify a complex system,
state House and Senate leaders have proposed dueling visions for the future
of the state system. The House solution envisions a system similar to
the one currently in place. It would put providers, essentially doctors
and hospitals, at the center of the process.
But the Senate version would privatize the process in favor of outsidemanaged
care organizations. Such a system would outsource the management of the
Medicaid program to a private company, which executives like Luckett say
would make it harder for doctors and hospitals to treat the state’s
“You’re talking about making it harder for providers to treat
their patients, and that makes it harder on the entire system,”
On the front line
Gastonia’s Lori Coates, a registered nurse, has battled pediatric
emergencies at times in her career and practically lived inside the operating
room at others.
“But what I’m doing right now might be the most rewarding work
I’ve ever done,” Coates said.
She’s a community care case manager with Community Health Partners
in Gaston County, a nonprofit that serves Medicaid patients in Gaston
and Lincoln counties.
It’s one of 14 community networks that make up Community Care of
North Carolina. The system manages public Medicaid dollars and doles out
payment to coordinate patient care.
It falls to RNs like Coates and other specialists to act as the bridge
between primary care providers and particularly difficult patient cases.
The idea is to help Medicaid patients, many of whom struggle to understand
what can be a complex system, understand how to help themselves.
Sometimes that means in-home visits to help patients understand treatment
protocols or simply how to take their medication, Coates said.
“But the idea is to help people before smaller problems become bigger
ones,” Coates said. “Sometimes, that’s as easy as picking
up the phone and answering their questions, but it’s really patient
The Senate bill, discussed as part of the state budget battle, would sever
ties with Community Care of North Carolina by Dec. 31.
Lawmakers have said they plan to pass a budget by Friday. The goal is to
change Medicaid from the current fee-for-service plan — one where
doctors and hospitals get paid for each visit and procedure — into
a program that would pay a set amount to manage each patient’s care.
The payment would go to a group of doctors or an insurance company.
That move could provide lawmakers with more budget predictability in terms
of the state’s Medicaid budget. It would also create a seven-member
board, called the Department of Medical Benefits, to oversee the program.
That would remove Medicaid from the Department of Health and Human Services
and likely shift the management of Medicaid away from local providers
and nurse teams like the one to which Coates belongs.
Delays in care for the poor?
Four years ago, Kentucky moved half a million Medicaid patients to three
national managed care organizations. That move may have increased delays
in getting care, according to a 2012 report by the Urban Institute.
Critics of the proposal, like Luckett, say the current system is designed
with patient benefits in mind. He singled out Medicaid’s prenatal
care provisions, designed to help low-income mothers and their children
get quality medical care early in life, as a measure that heads off problems
before they start.
“As for how this will ultimately play out ... I don’t know
where the Senate’s head is, and I’m not sure where they’re
going with this,” Luckett said.