Joint Legislative Oversight Committee – NC Medicaid

The Joint Legislative Oversight Committee met on August 11, 2020 at 1:30pm.

The Committee heard reports about Medicaid Transformation, Medicaid enrollment, and Medicaid budgeting.

DHHS Secretary Report

Dr. Mandy Cohen, MD, MPH, provided overview remarks to the Committee. She noted that increasing access to affordable insurance is an important way for the state to fight COVID-19.

Dr. Cohen presented data from the Kaiser Family Foundation that concludes 13% of North Caroinians were uninsured in 2018.

She added that while the Families First Coronavirus Response Act allows states to pay for COVID-19 testing for the uninsured, it does not pay for treatment.

She remains hopeful that federal legislation will be passed. If there is federal funding, the NCGA would need to convene to distribute the funds.

 

 

 

 

Overview

There are 1.6-1.8 billion Medicaid beneficiaries will enroll in standard plans.

The beneficiaries will be able to choose from 5 prepaid health plans:

  • AmeriHealth Caritas
  • Healthy Blue
  • United HealthCare
  • WellCare
  • Carolina Complete Health (regions 3, 4, 5)

One added challenge in transitioning to managed care is the uncertainty in provider’s prioritizing contracting due to COVID-19.

DHHS is currently working with the Eastern Band of Cherokee Indians to develop a tribal option to go live in region 1.

 

 

 

 

Enrollment

Enrollment in Medicaid and NC Health Choice is expected to grow. However, the Department was clear that the pandemic will be a major factor in enrollment.

The Medicaid average memberhsip is expected to grow 8% through 2021.

 

 

 

 

 

Financial Update

For fiscal year 2019-2020 appropriations expenditure for Medicaid and NC Health Choice was $116 million of 3% less than budgeted.

The main drivers of growth for the 2019-2020 fiscal year were COVID-19 rates and policy. The main areas of savings were the lower claims volume from social distancing, the Families First Act FMAP bonus, and accelerated hospital supplemental payments.

 

 
 

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