McCrory’s Medicaid maneuvers

Published 12:00 am Tuesday, October 1, 2013

RALEIGH — Despite all the problems in his health agency, Gov. Pat McCrory has not backed down from the idea of turning the state’s Medicaid program into a privatized, managed-care system.
In three separate appearances lately, McCrory has reiterated his support for changing the program, which provides health care to the poor.
What the McCrory administration wants to do is have managed care companies oversee Medicaid, paying those companies a set monthly fee for each recipient enrolled. The change would make Medicaid a pure insurance program, creating an incentive for those companies to hold down costs.
The state now operates a fee-for-service program, under a model referred to as primary-care case management. Doctors themselves are given incentives to manage patient care in ways intended to make patients healthier and avoid higher-cost medical treatment.
A nonprofit, Community Care of North Carolina, oversees the case management and has been cited as a national model.
The McCrory administration first proposed the idea of privatized, managed care Medicaid in March.
Since then, the Department of Health and Human Services, which oversees the program, has been dogged with controversies, whether involving personnel and pay or computer systems that fail to deliver payments and benefits to legitimate recipients.
Despite the problems, McCrory, in comments to reporters, before a business group and on a TV news show, still seems to have visions of making the switch from a fee-for-service program to managed care.
To the Cary Chamber of Commerce, McCrory said he planned “some fairly controversial proposals to change Medicaid.” On a Sunday morning TV news show, “NC Spin,” he said, “There’s one piece of legislation I got put in the budget that’s a secret, don’t tell anyone. We got permission to ask for that waiver.”
The “waiver” refers to a request to the federal government to change the program.
The problem for McCrory is that it is no secret, and the language that he references hardly amounts to a full-throated endorsement of change.
Instead, state lawmakers, in a budget provision, allow McCrory to submit draft waivers to the feds to determine whether they will agree to any changes. The provision also sets up an advisory panel to begin coming up with recommendations to alter the program.
But legislators specifically say that the McCrory administration cannot make changes to the program without their approval.
Given some of the comments from Republican legislative leaders, the entire exercise could turn into a bit of bureaucratic and legislative wheel-spinning.
Legislative leaders have been pushing for more oversight and control of the case management entity, Community Care. They have not shown any inclination to dump the current operating model and anger the doctors who are happy with it.
McCrory and his aides better get a handle on those sentiments and the Medicaid landscape.
Otherwise, his talk of reform may only set him up for another legislative defeat.
Scott Mooneyham writes columns for Capitol Press Association.