Medicaid Reform

20140917_untitled0134The North Carolina Medical Society (NCMS) has been an integral part of North Carolina’s Medicaid reform process from our response to the state’s initial request for proposals in 2013 to the submission of the waiver request to the Centers for Medicare and Medicaid Services (CMS) to implement the General Assembly’s reform legislation in 2016. We will continue to participate in a meaningful way in this lengthy and oftentimes contentious process.

Guiding Principles of Reform

We are guided by the following key principles. To be successful Medicaid reform will:

  • Put the patient at the center, making certain the whole person is cared for, factoring in community services as necessary to sustain the person’s health.
  • Be led by physicians since they have the clinical knowledge to understand what constitutes excellent patient care.
  • Use quality performance measures that are meaningful, consistent across all entities, clinically relevant and are not an additional burden to physicians.
  • Be transparent in reporting data, quality measures, costs and savings.
  • Strive for administrative simplicity during the transition period leading to sensible and streamlined procedures once the system is in place.
  • Establish network adequacy standards to ensure access to care based on federal law or regulations.

Many of these principles were incorporated into the final Medicaid reform legislation passed in 2015.

Latest Developments

Much remains uncertain at this point, especially with the new federal and state administrations. It is unknown how long the federal approval process will take, but once approved the General Assembly has allowed 18 months to select the managed care organizations or provider-led entities to serve patients and begin enrollment. Many observers expect enrollment to begin as early as January 2018.

The NCMS has partnered with Centene Corporation and the North Carolina Community Health Center Association to form an innovative health plan, Carolina Complete Health, which upholds our long held principles. Read more about Carolina Complete Health.

Watch for the latest information and updates in the NCMS Bulletin as well as on our Bowtie Briefing video blog each Friday as the Medicaid reform process unfolds in North Carolina. You may access these news items on our website as well.

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