RALEIGH, N.C. -
Cost overruns and control are at the center of Medicaid reform. The Governor says he wants to save more on Medicaid now costing state taxpayers $3.5 billion.
In a standing room only hearing, the Department of Health and Human Services (DHHS) rolled out its plan to reform Medicaid on Wednesday. Secretary Aldona Wos says the shift to Accountable Care Organizations (ACO) is the key to this plan.
"We’ve reached a compromise and we think it is the right thing to do for North Carolina to have a plan that will work for our state."
The shift to ACOs moves our state away from privatization---which has been the goal in recent years. But the panel, charged with presenting its findings to the Governor and General Assembly agreed on the proposal.
“The General Assembly frankly in the last 3 years invested a considerable amount of money to clean up problems from the prior administration,” Rep. Nelson Dollar of Wake County said.
The panel met with the public on three occasions. Dr. Peggy Terhune sits on the advisory board and said, "The reason we got good proposals is because the stakeholder input was listened to."
DHHS says ACOs will share savings and losses with the state; they will also be responsible for quality of care. When it's all said in done, figures suggest the state will save 2% of its $13 billion dollar Medicaid shared budget with the feds.
“The key is sustainability; this is not just a matter of fixing something for the sake of fixing it,” Wos said.
“Well I disagree with your premise I think certainly during this last year we have been working closely with our LME-MCO partners and just the fact that we are consolidating them to many and we'll be down to four, which will be more efficient.”
The next step is for DHHS to present their plan to the General Assembly on March 17th and lawmakers say they hope to have a package ready and voted on by the end of the short session. ==== Previous version
North Carolina's Department of Health and Human Services is backing off its initial proposal to fix our troubled Medicaid system.
Initially, the plan to manage costs would involve hiring large managed care organizations to run the $13 billion system.
But DHHS presented its new plan Wednesday to an advisory group set up by Governor McCrory and lawmakers.
The new plan veers away from privatization, which has always been the goal, further utilizing existing MCOs and creating new entities called "Accountability Care Organizations."
Doctors and hospitals agree this is a much better way of going about it.
Senator Louis Pate of Pitt County serves on the advisory group and is firmly behind increasing state control.
"That's why the teachers can't get raises and other state employees can't get raises because all the moneys being sucked up by Medicaid due to inability to forecast what costs are going to be year to year," said Sen. Louis Pate, advisory member.
This is just a proposal.
The legislature won't decide on the final plan until May.
By utilizing the networks already in place, doctors and hospitals would keep money it saved.