Gov. McCrory to announce Medicaid plan
April 3, 2013 3 Comments
later this morning in a speech/press conference at 10am Eastern (an intro vid is down this link; no specifics, but nice music). Here is a livestream link that will allow you to watch the press conference live.
I have written lots about North Carolina’s Medicaid program and potential expansion under the ACA. You can see these posts by using the Medicaid tag.
I have been sticking with my prediction that North Carolina will eventually expand Medicaid via the ACA. The Governor will have to declare a victory of some sort to have a chance to pull that off politically. Today’s announcement is a part of that political dance regardless of the details, but I don’t know what will be announced. No need to do tea leaves now, the presser is in 30 minutes.
The most important thing to remember where you hear Medicaid, is that it is not one monolithic program. The expansions available through the ACA are focused on the young, and particularly childless adults. However, the most expensive part of the Medicaid population are elderly persons (dual eligibles because they have Medicare and Medicaid) and the long term disabled.
Update after watching the press conference (10:55am)
- I give them credit or doing something
- Details were scant; that should change. No word on expansion, but this is the start of being able to declare victory that will lead to that
- Plan to ask for a 1115 waiver from Medicaid; Sec Sebelius has offered help in developing the plan, and the State is accepting this offer. 1115 waivers are typically used when you want to offer a pared down benefit package and/or changes in choice of provider, etc. Such waivers (1115) have to be cost neutral
- Aspiration seems to be a bidding process whereby there will be “3 entities” that will have contracts to deliver Medicaid services. Entities were described as next generation provider networks (State version of ACOs?, but much larger; first thing I thought of was the health care cooperatives proposed in the Clinton plan, which were to be about the size of congressional districts in terms of population covered; sure that is not how they will message it). Key stated goal is to better coordinated services (physical, mental, substance abuse) which were described as silos now. This is true, but not just for Medicaid. It is a hallmark of the entire system. Medicaid is just a payer into a fragmented system, but it is true that it disproportionately covers those with complicated “long term care meets acute care” needs, both in the young due to lack of other coverage and in the elderly due to low wealth levels, often due to paying for LTC.
- Wants the 3 entities to bid for care provision of Medicaid beneficiaries and put these 3 at full financial risk.
- Info System improvements, saying there will be one IT and one financial system required
- My biggest question goes back to the basic Medicaid reality that it is not one program. Do they intend to bid the Medicaid part of dual eligibles out and long term disabled? This includes massive Nursing Home costs. The concept of improving health for many such persons is difficult to discern, and so to put providers ‘at risk.’ If duals will be included, that is going to difficult, and if no, they are exempting the most expensive part of the system.
- Need more details to be able to say much more. Bottom line: credit for doing something, it is quite vague at this point, but they fact that they are working with Sec. Sebelius and HHS is a positive sign politically.
I have nothing written on the plan, and can get nothing from sources that often have such info early.