NC Senate Votes for Medicaid Managed Care

Today the North Carolina Senate tentatively voted 28 to 17 to use outside managed care corporations as part of their Medicaid reform plan. (See the roll call.)The North Carolina Medical Society (NCMS) has adamantly opposed this type of solution and has worked for more than a year in collaboration with legislators, the Department of Health and Human Services and the Governor to develop a homegrown reform plan that addresses the needs of patients as well as the budget predictability sought by the General Assembly. The NC House, the Governor and other health care stakeholders support this alternative to managed care.

Immediately after the Senate vote today NCMS sent the following statement from NCMS EVP/CEO Robert W. Seligson to media statewide:

“Today the Senate had a clear choice between the health of our state’s most vulnerable citizens and the health of Wall Street corporations, and they chose the corporations. Despite strong alternative proposals from the North Carolina House, Governor McCrory and the health care community on the best way to improve patient care and quality and provide budget predictability, Senators voted against this consensus. Outside managed care companies have a dismal track record of success. The Medical Society would like to recognize and appreciates the bipartisan support for the consensus plan of the health care community, the House and the Governor on the Senate floor today. It appears that the 28 senators who voted for managed care are not aware or don’t care about the negative history of managed care and are welcoming it to North Carolina.”

For instance,

  • Kentucky moved 550,000 of its Medicaid patients to three national managed care corporations in 2011. Since then, a 2012 evaluation by the Urban Institute found that patients faced delays in getting care, and there was an adversarial relationship between the managed care plans and the medical community. State legislators continue to be flooded with complaints and passed a bill to set up an appeals process at the Department of Insurance to mediate disputes between the medical community and the plans. One of the managed care plans pulled out of the state last year, suing the state saying it lost money and forcing 125,000 patients into the other two plans.
  • In Illinois, a federal judge awarded over $334 million in a fraud lawsuit against the Medicaid HMO Amerigroup Illinois and its parent company, Amerigroup Corporation, for systematic and extensive fraud for discriminating against pregnant women and those with expensive medical conditions.
  • In Georgia, their Medicaid program was fined $3.7 million for consistently refusing to pay for authorized care.

 

 
 

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13 Comments

  • I would like to invite those 28 Senators to come spend a day with my doctors in our pediatric office with 60% Medicaid and then tell me that I need more hassles to get paid less. Incredible.

  • Stephen Mencik

    For those asking for the list of the senators and how they voted, a link to the roll call is included within the article.

  • Geoffrey Zeger, ACSW, LCSW

    It is unclear if the Senate proposal will go through, but as a Direct Enrolled Medicaid Provider working in the Mental Health field, and as one who has gone through the implementation of the Medicaid Mangled…sorry…Managed Care system here in NC (otherwise known as the Medicaid 1915 b/c Waiver), I must say the transition was bedlam. The transition serves as a warning for the Senate’s proposal. Perhaps the legislature thought ‘you have to break a few eggs to make an omelette’ when they approved the Waiver but boy – there were LOTS of broken eggs and it is unclear if there were any omelettes. Now that NC has had its MH/DD/SA services under a managed care system for a little over one year, it is unclear if there is even a sunny side up. I am still waiting to see if there is outcome data one year post Waiver implementation – are costs down? hospitalizations down? wait times in ER’s down? The results are unknown but what is known is thousands of mental health providers stopped taking Medicaid and many others were audited out of existence. What do you think happens to the clients when providers and agencies close? There were several times as the Waiver wave was sweeping through when I had to turn on a dime when an agency closed or dropped Medicaid and refer clients out – many fell through the cracks trying to connect with the new provider. I have many many many stories about the cracked eggs as the Waiver was implemented but suffice to say that if ALL of NC’s Medicaid services have to go through a transition like the implementation of the LME/MCO structure than we can see MANY health care providers dropping out of Medicaid, businesses closing, and clients having gaps in care. No – this is not hyperbolic thinking – this is a realistic extrapolation based on the real life events that occurred when the mental health system went from fee for service to a Medicaid Managed Care model in 2012. Let us hope that this deform…sorry…reform does not occur and that alternative/cost efficient/clinically appropriate changes are implemented instead.

  • Harry Ballard

    Its time to ration care to the Senators not supporting us. I would urge the physicians to refer those who have such low regard for the medical community elsewhere.

  • Sherri McClanahan - CPC

    This is another disappointment in our Government. The best interest of the providers, patients and citizens of NC is not on the conscious of the 28 Senators that voted for this. What is in this for them? What are they getting out of this from these MCO’s? We cannot get the majority of our claims paid by these MCO’s that are just handling the mental health benefits, I do not want to even imagine what it will be like when they handle the rest of the Medicaid benefits. Providers, patients and citizens are all suffering financially due to these continual changes that are unsuccessful.

  • Edward Plyler

    Hopefully this will not stand; if it does, our state will rue the day, and the progressive leadership of Gov. McCrory will be derailed. So disappointing that Senators would think this way. We need to know the ” 28″

  • Suneya G. Hogarty, DO

    What a disappointing day for our most vulnerable citizens and for those of us who continue to provide quality, conscientious, heartfelt care despite the many Medicaid obstacles over the last year. The Senate today, has dealt a deep blow and vote of “no confidence” in it’s physician citizens. I will be returning that vote at the ballot box soon. I cringe at the thought of the many useless, time-consuming, insulting-to-my-professionalism battles heading my way as a result of today’s decision. My thanks, on the other hand, goes out to NCMS who continues to show thoughtful leadership on so many fronts, and who speaks the truth in plain English, on behalf of physicians statewide. I applaud your written response to the Senate’s decision. I hope to see it printed in my local newspaper!

  • Vic Bustard

    Can NCMS send out a report on the Senate vote to include the names of the senators who voted for and against the Senate Bill? Also, what does ‘tentatively’ mean in this context. Thanks, VB

  • Harry Gallis

    This is a sad example of the Senate’s abdication of its responsibility to provide for the health and welfare of the citizens of our state. These companies will expect a profit at the expense of hospitals and physicians that are ethically and morally bound to provide appropriate and effective care regardless of the cost. Another example of the sacrificing of the public’s health and education for the benefit of private enterprise.

  • Lindsey de Guehery MD FACP

    Would you please post the names of the 28?

  • This is another example of government at its best…. it is so disappointing for the citizens and physicians, hospitals of NC. We will all regret this a few years after it begins…..

  • Celeste

    I think this decision to overhaul the system is a good one. There is so much abuse of this program designe for the most vulnerable. Having a network of providers and closer management of expenditures is the best way to ensure its sustainability going forward.

  • Douglas Sheets MD

    Since the Senate has little care for physicians or our patients, I would prefer to retire than handle the hassle of a managed care HMO.