RALEIGH — Gov. Pat McCrory wants to overhaul the state’s Medicaid program by having managed care companies offer health care plans for poor children, the elderly and the disabled.
McCrory said Wednesday that the change would benefit health care providers, patients and the state. About 1.5 million people are enrolled in the government health insurance program.
Managed care companies would receive a set amount of money for each person enrolled in their health-care program. The state and federal government spend about $13 billion on Medicaid in the state, with the federal government picking up more than 60 percent of the cost.
The change would bring predictability to Medicaid expenses, which the state has trouble estimating from year to year. McCrory said that patients would be healthier because one company, the administration is calling them “comprehensive care entities,” would be responsible for overseeing their physical and mental health needs.
“We are proposing to overhaul the entire Medicaid system,” said Aldona Wos, secretary of the state Department of Health and Human Services. The change will “provide comprehensive care, better outcomes, better customer service, better efficiency and sustainability. To do this we must be bold.”
The change would be significant for the state, which until now has relied on a home-grown managed care agency called Community Care North Carolina to create networks of doctors to care for Medicaid patients and work with people with chronic illnesses such as asthma. CCNC would be able to compete for a contract to offer one of the health plans, but it appears the CCNC would not continue in its current form. CCNC, a nonprofit, has been lauded as a national model for Medicaid management and received a national award for quality and efficiency Wednesday.
The state must receive federal approval to make the change announced Wednesday, but state officials hope to have it in place by 2015.
Reaction to the proposal was mixed. The N.C. Medical Society, which represents doctors, said it wanted to learn more about the idea, but was critical of handing the job to profit-driven companies.
“If the administration’s idea of reform is bringing in out-of-state corporations so they can profit by limiting North Carolina patients’ access to health care and cutting critical medical services to our state’s most vulnerable citizens, that is not change we can support,” CEO Robert Seligson said in a statement.
He described CCNC as a homegrown nonprofit that addresses the problems McCrory identified. “We question the wisdom of handing this important function off to Wall Street,” Seligson said.
Dr. William Roper, CEO of UNC Health Care, called the administration plan “a bold initiative to improve Medicaid.”
“I look forward to working with them and others on this important endeavor to better serve North Carolina’s patients,” Roper said in a statement.