Under the Dome

Gov. Pat McCrory signs waiver request to feds for Medicaid changes

Hours before submitting a waiver request to the federal government, North Carolina on Wednesday unveiled its finalized Medicaid overhaul proposal to lawmakers, with key provisions including privatizing the majority of services.

Rick Brajer, Health and Human Services secretary, explained to the House Health Committee that the reforms would shift the system from fee-for-service to private, managed care, thereby expanding patient options, saving money and improving care. Later on Wednesday at the Executive Mansion, Gov. Pat McCrory signed the waiver, which by state law had to be submitted to the federal Centers for Medicare and Medicaid Services by June 1.

McCrory reiterated that Medicaid reform had been an administration priority, criticized the program for mismanagement and claimed that after years of funding shortfalls – totaling $2 billion under the previous administration – DHHS had brought in Medicaid under budget for three years running.

In North Carolina, the Medicaid system covers about 1.9 million people and nearly 80,000 health care providers.

Privatization has been a goal for Republican lawmakers and reforms have been contentious ever since the state, in 2013, opted out of expanding Medicaid under the Affordable Care Act. During the committee hearing, Sen. Louis Pate, R-Wayne, told DHHS officials: “There was a lot of misgiving and doubt as to whether the department could push and shove us along to this place (reform), but they have done it.”

Brajer explained the waiver included input from 12 public hearings across the state earlier this spring, which he called “a beautiful example of democracy and process.” The waiver request will take roughly 18 months for federal regulators to review.

Opponents said they are wary of privatization and also charged that the waiver does nothing to address the nearly 500,000 uninsured North Carolinians in the so-called “Medicaid coverage gap,” who make too much money for Medicaid but too little to qualify for ACA tax credits.