After months of talk, legislators continue to disagree over the structure of the state Medicaid program and whether insurance companies should be allowed to manage patient care.
The differences reached a pivot point Tuesday when a legislative committee on health and human services voted to strip language from a proposal that envisioned insurance companies and provider-led care networks in regional competition for Medicaid patients. The overwhelming committee vote to eliminate the recommendation for commercial Medicaid managed care essentially leaves the decision on the program's future stalled where it was last summer, when disagreements over Medicaid slowed state House and Senate budget negotiations.
Rep. Nelson Dollar, a Cary Republican who opposes having insurance companies manage care for Medicaid patients, presented the successful amendment. The recommendation forwarded to the legislature offered only broad goals.
Dollar mentioned concerns about bringing commercial managed care into the state and over a proposal that providers take on all responsibility for managing Medicaid health care costs for all patients within "three years if feasible."
Sen. Ralph Hise, a Spruce Pine Republican who wants insurance companies in the Medicaid mix, called Dollar's amendment an attempt to "sabotage" progress.
The state legislature will return to work in January with unanswered questions about the health insurance program's future - how providers should be paid and who should oversee patient care. Medicaid is the government health insurance program for low-income children, some of their parents, the elderly and the disabled. The state and federal governments share the costs; the state is expected to pick up about $3.7 billion of the $13.8 billion budget.
Gov. Pat McCrory and legislators want to make the Medicaid budget more predictable and improve patient health. But there are different ideas on how to accomplish that.
McCrory's administration and leading House and Senate Republicans agree that the state should move away from the current system of paying providers for each service they offer. They want a system that allows the state to pay set amounts for patients according to care they're likely to need, and has providers take on all the financial risk for exceeding budget limits.
McCrory and Dollar, the senior House budget writer, and other House Republicans are in close agreement, but Senate Republicans continue to push for commercial managed care and a shorter time to get the plan in place.
Dr. Aldona Wos, secretary of the state Department of Health and Human Services, said the provider-led care networks will lead to better patient health, but they need time to become established.
"If we move too fast," Wos said, "we will do more harm than good."