Under the Dome

Doctors and hospitals deliver Medicaid pitch

Talk of how to change the state’s Medicaid system has been bubbling in the background of the legislative session.

There’s a divide among legislators on how to shift Medicaid from a system that pays for individual medical procedures and appointments to per capita payments. The change would convert Medicaid to a managed care system, and make some entity other than taxpayers – either insurance companies or groups of providers working together to manage patient care – responsible for unexpected overages.

Medicaid is the government health insurance program for the poor, elderly and disabled, and is the source of some of the legislature’s fiercest disagreements. A Medicaid standoff helped hold up adjournment of the legislative session last year. Lawmakers say they are committed to coming to an agreement this session.

A segment of elected officials (Gov. Pat McCrory and influential House members) want state health care providers to be in charge of Medicaid managed care. Another segment (a lot of Republican senators) want to allow commercial insurance companies into the state’s Medicaid market.

The N.C. Hospital Association and the N.C. Medical Society, both adamantly opposed to having commercial insurance companies covering Medicaid patients, published a proposal last week that would have groups of providers band together to provide health services.

The provider groups would move to per person payments in physical health within three years after the federal government approves the change. Mental health, dental services and long-term care would be integrated within five years of federal approval.

The federal government picks up most of the state’s Medicaid costs and the state must get its approval for big system changes.

A statewide committee would set quality assurance measures. The Hospital Association has the full proposal on its website.