Over the past few years, you have heard me (and others) complain about what the North Carolina Legislature has not done to help patients and health-care providers. I want to give you an update on what the legislature has done.
No, the Republican-controlled Legislature has not agreed to expand Medicaid to allow more people to pay their medical bills, as President Barack Obama and Democrats envisioned under Obamacare. But they have agreed to implement a Medicaid Managed Care program.
Basically, this program allows Medicaid recipients in North Carolina to choose private insurers – similar to the way Medicare recipients have been able to choose private insurers under the Medicare Advantage program. The program goes into effect a year from now – on July 1, 2019—and the rules have yet to be finalized. But the basic benefits of this new program already are clear.
Here’s how the Medicaid Managed Care program will work: The state will choose three statewide insurers and between three and five regional insurers to participate. Patients can choose from among those insurers. (The new rules do not apply to disabled patients, however – they will continue to use the existing Medicaid program.)
There are benefits both for health-care providers and for patients. A fundamental change for patients is that, when paying for care, they will use cards from a private insurer (whichever one they choose) rather than a Medicaid card. For many people, this is a dignity issue; Medicaid recipients will pay with cards that are no different from other patients’ cards. There will be no obvious way to tell that they are receiving government-subsidized health care.
For health-care providers, the new program will present some challenges – we will have a whole new set of rules to learn about how to submit claims, coverage limits, etc. But for providers like Piedmont Health, the new program also will have great benefits because it gives insurers more flexibility to implement value-based payments to providers. That kind of system rewards providers – like Piedmont Health – who provide care in an efficient and cost-effective way.
We think we are in a good position to maintain the high quality of patient care with the resources that will be available to us. At Piedmont, we accept all forms of insurance but we do not turn patients away because of ability to pay. Most of our patients pay for their care but we have had to find ways to provide care efficiently – and we have done so.
The new system will produce winners and losers, and we are confident we’ll be a winner. We have been aggressive and creative in keeping our costs low; for instance, we keep our pharmaceutical costs low by having an in-house pharmacy. And we provide high-quality care through such means as the partnership we have with the University of North Carolina School of Medicine.
Piedmont Health is one of 340 community health centers in this country recognized as a quality leader by the federal Bureau of Public Health Care. We think we’re in a good position to maintain high-quality care and continue to have the resources to pay for it. The new program will reward us for practices we have been doing all along.
The new program also provides a benefit for taxpayers – the tax dollars they send to the government for health care will be maximized.
North Carolina is not the first state to adopt Medicaid Managed Care; in fact, 70 percent of states already have it, so we are playing catch-up.
And it is not a substitute for expanding Medicaid – the Legislature still needs to do that. There are still too many people who cannot afford health care, and this is only a partial solution.
But the new program is a step in the right direction. It’s good to be able to report good news about health-care resources.