NCMS Morning Rounds 2-12-20

Happy Wednesday! Here is your

NCMS Morning Rounds.

Feb. 12, 2020

Legislative Committee Discusses Medicaid Transformation Delay

Senior officials from the NC Department of Health and Human Services (NCDHHS) yesterday updated the Joint Legislative Oversight Committee on Medicaid on the status of the state’s stalled transition to Medicaid managed care.

Deputy Secretary for NC Medicaid Dave Richard clearly laid out for the committee that Medicaid managed care cannot occur under the state’s continuing resolution budget. Due to a stalemate between the Governor and legislators over passage of a new state budget, state government has been operating under a continuing resolution of last fiscal year’s budget since July. Richard told committee members that a new budget must include authority to pay the capitation payments due the managed care plans that received state contracts and authority to use the transformation dollars. The ‘right’ budget is needed, he said, in order not to destabilize the Department during this critical transformation.

NCDHHS suspended the move to managed care indefinitely in November 2019, about 75 days before the new program was to ‘go-live’ on Feb 1, 2020. Up to that point, Jay Ludlam, NC DHHS Assistant Secretary for Medicaid, told the committee NCDHHS had been on track to launch the new managed care program, and he outlined the many steps taken to engage with physicians to get medical practices and other stakeholders ready for the massive change. With the suspension, the health plans holding state contracts to administer Medicaid as well as the physicians and PAs enrolled in the program to provide services were left hanging, already having invested in the transformation.

Legislators expressed their displeasure with the suspension and closely questioned Richard and Ludlam on what the delay is costing physician practices and the health plans, and what the impact might be on employees.

NCDHHS did not put a dollar amount on the delay, emphasizing the Department is doing all it can to continue moving forward with elements of the transformation that are low impact as far as money and staff time in order to keep some momentum going.

When pressed by Committee Co-Chair Sen. Joyce Krawiec (R-Davie) on how to break the log jam and move forward, Richard urged legislators and the Governor to “sit down and really have a conversation about the best budget to move the state forward.”

Committee Co-chair Rep. Donny Lambeth (R-Forsyth) compared the situation to a recent UNC-Duke basketball game in which UNC was up 13 points, ready to win the game, when because of some unfortunate plays, they lost all momentum and Duke won the game.

Medicaid transformation is “a unique opportunity for North Carolina to do something special,” he said. “Whatever is causing it to bog down we need to address it. We need to get this done.”

Early voting Starts Tomorrow – Get Ready!

Early voting for the March 3 primary opens tomorrow, and now is the time to make your voting plans.

See where all the early voting sites are in your county and the hours they are open.

Review your ballot before you go to the polling place, so you know your choices.

If you would like more information on how the various local candidates stand on issues important to the medical community in North Carolina, please contact NCMS Director of Legislative Relations Sue Ann Forrest, MPA, or 919-833-3836.

Early voting continues through Saturday, Feb. 29, so you have lots of options as to when to cast your vote if you think you may be busy on primary Tuesday, March 3.

Crucial Conversations: Health Equity and Maternal and Infant Mortality

The NC Justice Center and their online publication NC Policy Watch, hosted a ‘Crucial Conversation’ yesterday in Raleigh bringing together stakeholders from throughout the community to learn and exchange perspectives on racial disparities in maternal and infant mortality in North Carolina.

Raleigh News & Observer reporter Lynn Bonner, who was part of a panel at the gathering, recently published several articles detailing the gap between black and white infant deaths in North Carolina. Data show that black infants are 2.4 times more likely to die than white infants in the state today, statistics that are worse than in 1999. [Read Bonner’s stories: Urban or Rural, Black Lives in NC Are Being Cut Short Almost Before They Begin, and Here’s What Could Save More Black Infants’ Lives. But NC Isn’t Doing It.]

At the NCMS’ Maternal and Infant Health Summit last October NC Department of Health and Human Services (NCDHHS) Secretary Mandy Cohen, MD, MHS termed this reality “an atrocity,” saying “we need to address it.”

Bonner and the other panelists, Whitney Tucker, Research Director at NC Child; Rebecca Cerese, Engagement Coordinator for the NC Justice Center’s Health Advocacy Project and Tina Sherman, Campaign Director for the Breastfeeding and Paid Leave Campaigns at MomsRising, explored policy shortcomings as well as systemic problems like racism and poverty that contribute to infant and maternal health disparities.

“The reasons behind the disparities do not fit into a tidy package,” said Bonner, who has covered the legislature and Medicaid, and spent seven months researching and writing her stories. The problem – and the solutions – are complicated and will require honest and uncomfortable conversations, the panelists agreed.

Several black attendees shared personal stories of not being heard by white medical professionals. One white nurse midwife in the audience asked what she as a clinician could do immediately to address these issues.

One simple thing Tucker from NC Child offered was to ask patients, “What are your questions?” rather than “Do you have any questions?” as a subtle way to prompt the exchange of information. Another question might be, “Do you feel respected here?”

All the panelists agreed that having difficult conversations around racism is crucial along with a willingness to examine your own biases.

In the News

1 in 5 Surgery Patients Hit with Surprise Medical Bill, JAMA Study Finds, Healthcare Dive, 2-11-20

Learning Opportunity

The NCMS and the NC Healthcare Association will host the next meeting of the NC Population Health Collaborative on March 12 from 11:30 a.m. to 3 p.m. at Wake Tech Community College – RTP Campus in Morrisville. Seating is limited, so register as soon as possible. Learn more and register.


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