Interview with Sec Wos and Director Steckel
April 12, 2013 1 Comment
Rose Hoban interviews N.C. Health and Human Services Secretary Wos and State Medicaid Director Steckely. There is a very revealing, 15 page transcript of the entire interview embedded in the story. More later on this, but quick thoughts:
- The Governor clearly said we could not expand Medicaid because it was broken. Administrative overruns were cited as the main way the system was broken.
- The degree to which NC Medicaid has unusual administrative costs is in some doubt; especially states using more managed care don’t call some of the admin costs admin (more on that next week)
- Medicaid is a counter cyclical program whose beneficiaries rise when the economy is bad; it is impossible to precisely estimate the number of beneficiaries. Medicaid is surely a difficult item for all states to budget for due to this, but at least some of the budget overruns in N.C. the past few years have been related to fighting between a Democratic Governor and a Republican General Assembly. We don’t have that issue now.
- I agree that coordination of care for complicated patients, especially those with mental health and long term care needs leads a lot to be desired. I am ready to cheer on efforts to improve these issues in N.C. Medicaid…but the Medicaid expansion would mostly not add such folks to the eligibility roles, but instead add mostly childless adults, who do not now qualify based on disability.