Medicaid Meeting in Durham

North Carolina HHS Secretary Wos and Medicaid Director Steckel have been giving interviews and traveling around the state talking about the nascent Medicaid reform plan that Gov McCrory calls the Partnership for a Healthy North Carolina (this 11 slide presentation is the only written overview I have). The details of the plan are somewhat unclear, but the goals are fairly grand: they want private ‘entities’ to compete to deliver the full Medicaid benefit package in every county in the State. In doing so, they want to ensure the ‘whole person’ is treated, with special emphasis on integrating mental with physical health.

There is a good bit of political momentum behind the nascent plan, as Speaker of the House Tillis and President of the Senate Berger joined the Governor in pledging to move ahead with this direction. However, there is more political agreement that something called the Partnership for a Healthy North Carolina will be done, than there are details of exactly what shape the plan will take.

I think any fair observer would have to note than than sales pitch has been rocky so far. On May 10 in Reidsville, Sec. Wos said that the State Health Insurance Commissioner was the one who decided that N.C. would not expand Medicaid; this of course is not true. The N.C. House and Senate passed a bill declining that the Governor signed, and he stated clearly from the beginning of his term in January that he was not ready to move ahead with expansion because Medicaid was ‘broken.’

Did Secretary Wos just say this to survive a tough moment in the public hearing (she was being pressed about N.C. not expanding Medicaid; here is the audio of the snippet)?  Or did she not really understand what had happened with N.C. rejecting the Medicaid expansion? Neither explanation is particularly reassuring.

I attended the public meeting May 15, in Durham (~200 people)  and there were two sentiments that got rapturous applause:

  • That North Carolina should undertake the expansion available under the ACA while improving the system
  • That North Carolina should not privatize Medicaid via 3-4 ‘entities’ and instead should build from the success of Community Care of North Carolina (which is really an integrated primary care network that cares for Medicaid beneficiaries)

To say there was and is broad skepticism about the direction to which the Governor and now the leadership of the House and Senate have committed is a polite understatement. And to a person, the skeptics know that health reform in Medicaid and otherwise is ongoing and will likely never be done.

I will blog through some specific thoughts and concerns I have about this nascent plan over the next few weeks.

About Don Taylor
Professor of Public Policy at Duke University (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute). I am one of the founding faculty of the Margolis Center for Health Policy, and currently serve as Chair of Duke's University Priorities Committee (UPC). My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

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