Speakers at the first three public hearings this week on the state’s planned Medicaid overhaul said they wanted the government insurance program expanded to cover more people, worried that increased paperwork would drive away doctors, and asked why the state is changing the system at all.
The state Department of Health and Human Services is preparing to ask the federal government to approve major changes in Medicaid that will have most of its beneficiaries sign up for health plans run by insurance companies, hospitals or other providers. Privatization of Medicaid – the government program for low-income and disabled citizens – was a priority for legislators last year.
State health officials said the changes will give beneficiaries more options, improve health and contain costs. But the major element of the reform plan is to change the way doctors and health providers are paid. The state would no longer pay for each doctor’s visit or procedure, but would contract with multiple health plans and pay them each a set sum for each patient enrolled. The goal is to offer at least three statewide health plans and two regional plans in each of six regions.
Health care is a moral issue. Five hundred thousand people left out of a health care system that our taxes pay for matters to God, and I think it should matter to us.
The Rev. Rodney Sadler
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Medicaid covers 1.9 million people, mostly low-income children and their parents, the elderly and people who are disabled. It costs the state about $14 billion, with the federal government paying about two-thirds.
The legislature has chosen not to expand Medicaid under the Affordable Care Act even though expansion would give about 300,000 to 500,000 low-income adults access to health insurance. There’s been a steady public push for expansion over the years, and several speakers at the hearings in Charlotte, Monroe and Raleigh – including doctors, health advocates and uninsured citizens – said expanding Medicaid should be part of any overhaul.
Under the ACA, the federal government covers 100 percent of the cost of Medicaid expansion through the end of this year. After that, the percentage decreases to 90 percent by 2020 and beyond.
Support for expanding Medicaid
Of nearly 25 speakers at Thursday night’s hearing in Charlotte, many spoke in favor of expanding Medicaid.
“Please take care of the least of these,” said Deb McLean, a member of the League of Women Voters of Charlotte-Mecklenburg. “It bothers me that we talk about empathy, but we don’t live it.”
The Rev. Rodney Sadler of Union Presbyterian Seminary is one of the ministers who participated in “Moral Monday” marches in Raleigh that challenged action by the General Assembly. At the hearing, Sadler encouraged state leaders to consider “God’s judgment on the state of North Carolina.”
We need to remove barriers from (patients) getting to see their doctor of choice.
Dr. Rhett Brown, of Charlotte, president of the N.C. Academy of Family Physicians
He has led the state NAACP’s push to extend health coverage to as many as 500,000 impoverished North Carolinians shut out by the state’s decision not to take the federal Medicaid expansion money.
“Health care is a moral issue,” Sadler said. “Five hundred thousand people left out of a health care system that our taxes pay for matters to God, and I think it should matter to us. We do not need to reform the system, but simply need to close the gap by expanding Medicaid.”
More than a dozen people in the audience held up placards in support of Medicaid expansion when prompted by Madison Hardee, a staff lawyer for Legal Services of Southern Piedmont. “It is time for our state leadership to stop coming up with excuses,” she said.
No one representing the state responded to comments at the Charlotte hearing Thursday. But at the Raleigh hearing on Wednesday, DHHS Secretary Rick Brajer anticipated speakers’ emphasis on expansion and said it will be discussed with the federal government and the legislature.
“We’ll have the discussion,” he said. “Where we come out on it is where we come out on it.”
Concerns about red tape
The Medicaid overhaul envisions more than a dozen Medicaid health plans in the state. Doctors said they’re worried that an increased paperwork burden might force some of them to stop seeing Medicaid patients, and that would limit patient choice.
“Access. Access. Access,” said Dr. Rhett Brown, of Charlotte, president of the N.C. Academy of Family Physicians. “We need to remove barriers from getting to see their doctor of choice.”
In North Carolina, about 90 percent of practicing family physicians accept Medicaid patients, compared with about 50 percent of doctors in Florida, according to Gregory Griggs, executive vice president of the state Academy of Family Physicians. He said N.C. family doctors who treat Medicaid patients used to get paid at 95 percent of the Medicare reimbursement rate, but cutbacks in recent years have reduced that to 75 percent.
As it works today, doctors who take Medicaid patients bill the state, so there’s a single set of billing and credentialing rules. Under the proposed change, there would be at least five. Doctors who have patients in more than one Medicaid region could be dealing with even more health plans.
Several speakers encouraged the state to keep Community Care of North Carolina, the Medicaid program’s system for managing care delivery. It has been hailed nationally for its success at working with doctors and patients to provide the right care in the right setting for the least cost.
“CCNC is a national model,” said Bill Brandon, a retired health policy expert at UNC Charlotte. “Let’s stick with what works.”
Greg Gombar is chief financial officer for Carolinas HealthCare System, one of the state’s largest providers of care for Medicaid patients. Gombar said hospital bills amount to only about 19 percent of the state Medicaid budget, “but the potential damage to hospitals by reducing Medicaid reimbursement or inadvertently reducing or eliminating a stream of funding could cripple, not only hospitals, but also the services health systems provide outside of the walls of the hospitals.”
DHHS will hold nine more public hearings across the state through mid-April. Comments can also be sent by mail or email. For information: http://www.ncdhhs.gov/nc-medicaid-reform/public-hearings. The state plans to submit its application for a Medicaid waiver to the federal government by June 1. It will be three to four years before the changes take effect.