What the State’s Compromise Medicaid Reform Bill May Mean to Your Practice

On September 17, the legislature released their compromise version of Medicaid reform legislation. The conference report for HB 372, Medicaid Transformation and Reorganization, takes a hybrid approach to reforming the state’s current fee-for-service Medicaid program by allowing both commercial plans and Provider-Led Entities (PLE) to compete for Medicaid business in the state under a fully capitated system. Both the House and Senate have now passed this compromise legislation into law and the medical community now must look forward to the long road of implementation that lies ahead.

The North Carolina Medical Society (NCMS) has advocated since the beginning of the state’s Medicaid reform debate nearly three years ago for physicians to lead reform efforts, rather than relying on the standard corporate managed care solution so many other states have used to address budgeting issues within the program. With the introduction of managed care into the state, we must now focus our efforts on using this transition time to implement value-based, patient-centered care models for Medicaid patients.

“Medicaid reform is challenging, and we understand the difficulty of the decisions legislators faced,” Robert W. Seligson, CEO of the NCMS told the press. “We oppose the General Assembly’s decision to involve corporate managed care in our Medicaid program. Including some of the patient protections we requested such as performance standards based on quality, cost and patient experience is an improvement.

“This is not the end of the Medicaid reform debate,” he said. “We will continue to work with our partners and the state’s leaders on the many decisions that lie ahead to enable the delivery of high value medical care to our state’s most vulnerable citizens.”

Read a detailed summary (PDF) of what this legislation means to our Medicaid program and your practice.


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1 Comment

  • John A. Paar, M.D.

    This joins a wide range of foolish decisions on the part of this particular State House and Senate. Involving for-profit corporations inevitably involves increasing the de facto overhead on governmental Medicaid expenditures, as the corporations are in the business of making a profit, which must inevitably come from the dollars which could go to patient care. Reimbursement for physicians and other providers who actually do patient care is already low, so just one more siphoning out of precious funds for some of our sickest and poorest patients.