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In Case You Missed It

N.C. Tackles Medicaid Reform

Pat McCrory, Governor
Aldona Z. Wos, M.D.,Secretary

North Carolina Department of Health and Human Services
For Immediate Release
April 15, 2013
Contact Julie Henry 919-855-4840
julie.henry@dhhs.nc.gov

N.C. tackles Medicaid reform
by Travis Fain
Greensboro News & Record

Raleigh, NC - Gov. Pat McCrory's administration has begun a precipitous climb tackling the reform of one of the state's most complex and expensive programs: Medicaid. But is that a pinnacle he's headed for, or a cliff?

McCrory's new secretary at the N.C. Department of Health and Human Services, Greensboro's Aldona Wos, is gung-ho about overhauling the government health insurance, which serves more than 1.5 million for about $13 billion a year.

She's pursuing it with an energy familiar to those who know her as a political and charitable fundraiser. The retired physician promises the potential privatization of many Medicaid functions will be good for patients and doctors.

She's meeting with doctors across the state, pitching to a sometimes incredulous crowd. She has routine office hours for providers to visit her in Raleigh.

The plan is to find three or so entities - likely including private companies - to function as insurance companies for Medicaid recipients.

Each would operate statewide and patients would choose their company. Each likely would have different plans, but Wos said the state would write minimum care requirements "in cement for everyone".

Nurses and case managers would plan care with patients in a process similar to private managed care plans. The goal would be to keep people on their medication and out of the emergency room, to plan ahead for long-term care needs and keep Medicaid recipients healthier and cheaper to care for.

Each "comprehensive care entity" would get a set amount of money for each patient it signs. But the per-patient payments would be weighted for people who are more expensive to cover - the very old, or people with chronic illnesses, for example.

If the CCE can keep costs below what the state pays, it would turn a profit.

If not, it's on the hook for extra costs.

Wos and her Medicaid director Carol Steckel hope this will save the state money and make the annual Medicaid budget more predictable. That budget typically requires hundreds of millions of dollars from state coffers near the end of each fiscal year because of the hard-to-predict costs of caring for so many people.

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