With no state budget, North Carolina’s Medicaid overhaul will be delayed
An overhaul of Medicaid health insurance in North Carolina — in the works for years and already weeks into enrollment — will be delayed indefinitely because the legislature and Gov. Roy Cooper didn’t agree on a state budget that would fund the change.
The delay was first announced by Senate Republicans in a news release on Tuesday afternoon, followed soon by an announcement from the N.C. Department of Health and Human Services.
Existing Medicaid recipients have started enrolling and DHHS has started the work for the move to a managed-care system, in which the state contracts with private health insurance companies.
But without a state budget, the change can’t happen yet.
In the GOP statement, Sen. Joyce Krawiec of Forsyth County called it “another crisis of Governor Cooper’s own making.”
Cooper spokesperson Megan Thorpe said in an emailed statement that Republican legislators were “irresponsible to end the session without moving health care forward.”
The legislature adjourned for the year and is scheduled to return Jan. 14.
Blame from Cooper, Republicans
In the news release from DHHS, part of the Cooper administration, the department said the delay was due to the General Assembly not taking “needed action” to provide new spending and program authority for the transition.
In October, state DHHS Secretary Mandy Cohen sounded the alarm to lawmakers that Medicaid transformation could not stay on time, and would cost more money, without a state budget in place by mid-November.
The policy decision to revamp Medicaid was made during a previous legislative session, but the funding to implement it is in the budget that still hasn’t been passed. Cooper, a Democrat, vetoed that budget and then vetoed a separate bill containing the Medicaid transformation funding, House Bill 555.
“The General Assembly passed a clean stand-alone bill to provide the transformation funding Governor Cooper’s own DHHS secretary said she needs to do her job. His veto will force insurers to lay off thousands of people they’ve already hired as part of the years-long plan to transform Medicaid,” Krawiec said in the Senate GOP news release.
Tuesday’s announcement from DHHS said the budget and the standalone measure would have “left the department vulnerable to an unprecedented cut that would have had a crippling effect on its ability to provide services that protect people’s health and safety and moved the department out of Raleigh to Granville County. In addition, neither expanded Medicaid so that hardworking North Carolinians could afford access to health coverage.”
The revamp in the works is different from the proposed expansion of Medicaid to people who aren’t eligible now. Cooper supports expansion, which was a major reason he vetoed the budget.
“By choosing gridlock instead of negotiating a compromise, (lawmakers) delayed Medicaid transformation and broke their promise to vote on expansion, leaving 500,000 North Carolinians without affordable, quality healthcare,” Thorpe said in the statement from the governor’s office.
Cohen, a member of Cooper’s cabinet, said in October the delay in the overhaul would cost money as well as a loss of the agency’s ability to recruit and retain talented workers. Cohen didn’t have an estimate of how much the delay would cost.
Call center open
As of late October, 70,000 Medicaid recipients in North Carolina had enrolled in a plan. There are five insurance companies contracted by the state for the new managed care system: Blue Cross and Blue Shield of North Carolina, AmeriHealth Caritas North Carolina, UnitedHealthcare of North Carolina, WellCare of North Carolina and Carolina Complete Health.
DHHS announced a “wind-down process” would begin Wednesday. With the delay, Medicaid will stay under a fee-for-service model that pays for care, rather than changing to a managed care system that pays per person enrolled.
Enrollment in managed care will stop, but a call center at (833) 870-5500 will be open until Dec. 13 to field questions. Current Medicaid beneficiaries will be notified that managed care is not happening yet.
In October, Rep. Donny Lambeth, a Winston-Salem Republican, told Cohen he was very concerned about the Feb. 1 planned start date for managed care. He suggested pushing it off to July 1.
“I know you don’t want to do that and I know there’s consequences of delays,” he said. “I’m as anxious as anyone.”
On Tuesday, DHHS did not have a new start date for the program, and said it would not set one until it has the budget authority to do so.
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This story was originally published November 19, 2019 at 2:53 PM.
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