Under the Dome

Commenters give thumbs down to NC Medicaid managed care

Many North Carolina pediatricians warn that proposed changes to Medicaid would spell disaster for children’s health and pediatric practices.

The state is asking the federal government for permission to privatize Medicaid, the government health insurance program that covers low-income children, some of their parents, the elderly and the disabled. About 1.9 million people are enrolled.

“When you alter Medicaid, you’re altering children’s care more than anyone else’s,” said Dr. David L. Hill, a pediatrician with KidzCare Pediatrics in Wilmington.

More than 1,800 comments had been submitted to the Centers for Medicare & Medicaid Services by midday Tuesday. Collection of public comments is one of the steps required as the federal government considers the state’s request to move to managed care for Medicaid.

Two themes emerged from the comments: that the state should expand Medicaid and insure more people as allowed under the Affordable Care Act, and that Community Care of North Carolina, the state’s Medicaid management system that assigns patients to a “medical home” or main doctor’s office, is better than the overhaul state officials proposed.

Only a handful of comments supported the proposed changes. Most asked the agency to reject the proposal, and many of those comments came from pediatricians and their employees.

Ken Lewis, executive director of the N.C. Association of Health Plans, which supports the changes, said such opposition is rooted in fear of the unknown.

“Forty some-odd states have Medicaid managed care,” Lewis said. “I don’t see the physicians, particularly the pediatricians, have been overwhelmed or put out of business.”

Lewis said he is setting up meetings with health care provider groups to talk about their concerns.

The state Department of Health and Human Services said the comments gathered as part of the public process would be helpful to the agency and to federal officials.

The department and most state legislators want to move the program away from fee-for-service, where doctors and hospitals are paid for each visit, procedure and device. Instead, the state would pay set per-patient fees. Statewide managed care networks and regional networks of doctors and hospitals called “provider-led entities” would compete for patients. The federal government pays about two-thirds of the state’s Medicaid costs and must approve the changes.

Hill, a N.C. Pediatric Society board member, said children would be disproportionately affected by the changes because they make up the majority of people using the public insurance. Hill said the organization sought to get its message out to members about what changes to the insurance program would mean.

Three KidzCare locations in southeastern North Carolina care for about 40,000 children, Hill said, and about 80 percent are insured under Medicaid.

Hill said dividing the state into regions would make it difficult for children who need specialty care to get it, and the plan would increase the administrative burden on doctors’ offices.

The state’s Medicaid system, which includes CCNC, has been an example to other states, Hill said.

The comment period ends Wednesday.

Lynn Bonner: 919-829-4821, @Lynn_Bonner

Congress members, DHHS

Republicans representing North Carolina in Congress support the the proposed Medicaid changes, while Democrats oppose them.

“This reform will reward health plans that provide healthier outcomes for Medicaid patients while giving beneficiaries more options,” the state’s 10 House Republicans wrote.

U.S. Sens. Thom Tillis and Richard Burr wrote that the proposal is a reflection of the “innovative thinking that has distinguished health care in North Carolina for so many years.”

On Monday, North Carolina’s three Democrats in the U.S. House — Reps. David Price, Alma Adams and G.K. Butterfield — wrote to the federal Medicaid agency urging it to reject the proposal.“The fervor of North Carolina’s governor and legislative leaders to overhaul the state’s proven health care delivery system is all the more troubling given their adamant refusal to expand Medicaid under the Affordable Care Act,” their letter states.

It calls the changes “a complex and unproven model” that could jeopardize access to care, and alleges a lack of public input.

A spokesperson for the state health agency said in an email its proposal “is consistent with North Carolina’s history of health care innovation and was developed with stakeholders across the state.”

Staff writer Lynn Bonner and Dan Boylan of the N.C. Insider State Government News Service