Senate Medicaid plan a disaster for the poor in NC

As a practicing pediatrician in Eastern North Carolina for nearly 40 years, I have observed the maturation of our Medicaid program as it has become the envy of other states. Community Care of North Carolina is all about the patients and quality of care: primary care networks, community-based care coordination by real people who live in our communities, fair payment for providers, a reduction in the use of emergency departments and a reduction in orders for unnecessary prescriptions, procedures and treatments.

Actuarial studies by independent consultants have shown savings of nearly a billion dollars during a four-year timeframe, compared with a traditional Medicaid model.

CCNC is authorized to influence only about 45 percent of the costs of Medicaid . The state has wisely moved the majority of high-cost aged, blind and disabled adults into CCNC. But another major cost center, dual eligible adults (those covered by Medicare and Medicaid), most in nursing homes, are not enrolled in CCNC medical homes. And mental health services, a significant portion of the budget, are managed by a separate delivery system that is outside the purview of CCNC.

The Senate plan to reform Medicaid reflects a focus on controlling costs. Senate leaders are eager to jettison CCNC, a working system that provides good access to primary care and effective case management. Physician leaders and state government administrators operate CCNC. The Senate plan would replace CCNC with out-of-state for-profit insurance companies. The track record of these companies with low-income patients in other states is not encouraging. Such patients need significant local assistance if they are to access care and follow through with treatment recommendations.

The majority of patients in CCNC are low-income women and children. Costs for this population are well-managed and do not represent a cost spiral. If senators truly want to cut Medicaid costs, they should authorize CCNC to move to value-based payment for providers, enhance quality improvement programs and take over management of the state’s dual eligibles. These should be our “next steps.” It is not the time to turn over this needy population to for-profit out-of-state insurance companies that will neither improve care or save money.

A key fact in Medicaid reform that is being overlooked is that, overall, N.C. Medicaid costs have been extremely stable. In fact, the cost per enrollee is going down. Budget overruns have been the result of poor budgeting practices, inaccurate forecasting and the difficulty of accounting for massive changes in federal match payments during the Great Recession. It appears that state government administrators have now put systems in place that will better track and predict future costs and enrollment in Medicaid.

The Community Care infrastructure built over two decades is a precious asset. If it is tossed aside for political or ideological reasons, North Carolina will lose this valuable system forever – it cannot easily be rebuilt. Many good people – including the state’s foremost physician leaders – have worked tirelessly since the early ’90s to develop Community Care. It is a system that works for patients, families, providers and taxpayers.

The Senate plan would waste major investments in a solid infrastructure and more than 20 years of experience learning how to effectively take care of our neediest citizens. For-profit out-of-state insurance companies do not really know how to take care of low-income patients at the community level, so the Senate plan would be a disaster for this population.

There are ways to improve Medicaid in our state, but the Senate plan does precious little to make sure our program better serves the patients who need Medicaid. The House and governor should not accept it..

David T. Tayloe Jr., M.D., of Goldsboro is past president of the NC Pediatric Society and American Academy of Pediatrics.