The North Carolina General Assembly passed Medicaid overhaul last week in a compromise deal between legislators and the governor, setting up the state for what leaders hope is more cost reliability and reliable coverage for those using the system.
Legislators finally approved HB 372 last week and Gov. Pat McCrory signed the bill on Sunday. The law seeks to largely privatize the system and move from a procedure-based system to a patient-based system, in which the state pays a set amount per patient and costs are more predictable.
The plan comes as a culmination of more than three years of negotiations resulting in a system based on managed-care organizations. The move pushes more of the risk off of the state and more onto the private sector.
The overhaul is scheduled over a multi-year period under the bill, beginning with a report to the Joint Legislative Oversight Committee on Medicaid and NC Health Choice by the Department of Health and Human Services (DHHS) through the newly formed Division of Health Benefits in March of next year.
The Oversight Committee will be made up of 14 legislators, seven from each chamber. The Division is tasked with drawing up and submitting a series of waiver requests from standard federal Medicaid policies to the federal Centers for Medicare and Medicaid services by June 1.
Assuming the waivers are accepted, 18 months after their acceptance contracts are to go out and initial recipient enrollment will be completed.
Care providers involved in covering Medicaid patients
Under the bill, the state will be divided up into about six sections, with provider-led entities (PLE) covering those areas providing both care and coverage to patients. A second statewide portion will involve PLEs bidding and managed care organizations (MCO) to bid on three statewide slots to provide coverage.
Critics worry that PLEs will not be able to compete with the resources of MCOs. Some critics also say that the change will incentivize companies to perform fewer procedures on patients, maximizing their profits while marginalizing the people served Medicaid.
Bill faces greater opposition in House
The Medicaid overhaul law passed the Senate in a 33-15 vote, with the only Republican in opposition being Sen. Jeff Tarte (R-Mecklenburg). Two Democrats joined Republicans in voting for the Medicaid overhaul, Sens. Floyd McKissick (D-Durham) and Ben Clark (D-Cumberland).
In the House the bill faced more opposition in a 65-40 vote following two hours of debate on the House floor. Only Rep. George Graham (D-Craven) joined 64 Republicans who voted for the overhaul.
Five Republicans opposed the bill, including House Speaker Pro Tem Rep. Paul “Skip” Stam (R-Wake) and head budget writer Rep. Nelson Dollar (R-Wake). Rep. Michael Speciale (R-Beaufort) also opposed the bill.