Under the Dome

Medicaid cost mystery mounts, holds up NC Senate budget

Medicaid math is complicated, and it’s harder still when some of the numbers are missing.

The state Department of Health and Human Services owes medical providers nearly two years’ worth of Medicaid payments for treating poor, elderly people. In addition to catching up on overdue bills, calculating payments the right way will change how much the state expects to spend in future years on the health insurance program for the poor.

As of Tuesday afternoon, the agency had not provided Senate budget writers with any figures. The lack of information is holding up the state Senate’s budget proposal.

“It’s all out there in the ether,” said Sen. Louis Pate, a Mount Olive Republican and one of the authors of the Senate’s health budget.

The N&O first reported on the budget problem in Monday’s editions. A DHHS spokeswoman said in an email late Tuesday afternoon that the agency was still gathering information it needs to answer questions about the payments.

State budget director Lee Roberts had said DHHS was working hard to calculate the numbers, and would know the costs “sometime” early this week.

State Medicaid has been underpaying medical providers who care for poor, elderly people who have both Medicare, the federal health insurance for the elderly, and Medicaid, government health insurance for the poor, which is funded by both the state and federal governments.

The problem dates back to July 2013, when the state started using new Medicaid payment software it calls NCTracks. The state says it started paying correct amounts this March.

The lack of cost information complicates the task of finishing a budget, said Sen. Harry Brown, a Jacksonville Republican and one of the Senate’s lead budget writers.

“We’re just waiting for something that’s a solid number,” he said. Legislators were hoping for news later Tuesday or Wednesday, Brown said.

Medicaid costs the state about $3.5 billion a year.

Having passed its budget proposal, the state House is moving forward with its version of “Medicaid reform,” or who should be responsible for managing Medicaid money and patient care.

Both House and Senate Republicans want to stop paying medical providers for each Medicaid patient’s hospital visit and procedure. They want to move instead toward paying a set amount per patient and having organizations use that money to manage care.

House Bill 372, set for committee debate Wednesday, would have groups of hospitals, doctors, or other providers be responsible for taking care of patients within these set budgets.

Senate Republicans, however, want commercial insurance companies to be able to compete with in-state providers for the state’s Medicaid managed care business.

Bonner: 919-829-4821;

Twitter: @Lynn_Bonner