Medicaid Expansion In NC?

North Carolina is one of 16 states nationwide that still hasn’t expanded Medicaid, even though (or because) Medicaid expansion is a key component of the plan behind the Affordable Care Act. With a major election looming this year, what is the status of the Medicaid expansion debate in North Carolina?

The League of Women Voters of Orange, Durham and Chatham Counties is hosting a discussion on Medicaid expansion this Wednesday, January 20, at 6:30 pm in the Chapel Hill Public Library. (The LWV is a nonpartisan organization, but it’s taken a position in favor of Medicaid expansion.) League president Janet Hoy will speak along with Adam Linker of the NC Justice Center.

Janet Hoy previewed the event and discussed the issue with Aaron Keck on WCHL.


Wednesday’s event is called “Status of Medicaid Expansion: What’s On the Political Horizon?” It’s free and open to the public.

Visit for more information.

HIV Survival Rates Disproportionately Low in South

Survival rates for those infected with HIV/AIDS in the South are the lowest across the nation.

Nine southern states, including North Carolina, are hit disproportionately hard by HIV/AIDS, according to new research out of Duke University. The study found 15% of those diagnosed with HIV, and 27% diagnosed with AIDS, died within five years of their diagnosis, based on numbers from 2003 – 2004.

Lee Storrow, Executive Director of the North Carolina AIDS Action Network, says the disease has grown beyond its initial profile of mainly affecting young-to-middle-aged white gay men.

“Unfortunately, we have really seen this disease evolve over the last 20 years,” he says. “[We’re] seeing a new focus and new outbreaks amongst poor residents of this county – and a concentration of new epidemics in the South.”

Storrow adds many factors play into the increased HIV rates – and the lower survival rate associated with the disease – particularly in our region.

“When you look at poverty rates in the deep South, when you look at lower levels of education, and you look at the social stigma,” he says, “I think all of those are factors that are contributing to increased rates of HIV in the South.”

Storrow says the stigma associated with the disease is a major obstacle in battling its treatment.

He adds, while sexual contact is the main form of transmission, the disease can also be passed by sharing needles, among other avenues.

Unfortunately, Storrow says our social environment can be deadly for those who are HIV positive.

“That stigma is something that means that people don’t share their medical conditions. They don’t receive testing,” he says. “And there’s a number of people who have received testing, and might know that they’re HIV positive, but aren’t actually in care to receive the treatment that they need.”

He adds battling the stigma is difficult on several layers, including not being able to legislate against a social stigma as you can with other more overt obstacles.

Of what can be controlled, access is a major theme for treatment, according to Storrow.

“One thing we know,” he says, “is that if you have access to stable-consistent-safe housing, you’re ability to access medical care significantly increases.”

And access to steady-affordable medical care can then translate to more effective treatment of the disease.

Storrow says the biggest way state legislators can help in the fight against HIV/AIDS is by expanding Medicaid.

He adds it will take teamwork – between lawmakers, everyone in our community, and beyond – to fight back against HIV/AIDS.

UNC Develops Online Tool to Predict Doctor Workforce

Professors from the Center for Health Services Research at UNC has developed a new online tool, which will allow anyone to have a more visual glimpse into the future of the healthcare workforce.

The FutureDocs Forecasting Tool will allow health care providers and anyone interested to be more aware to fluctuations in what specialties of doctors will or will not be available in the near future. With the possibility of adding Medicaid to the Affordable Care Act, there comes the risk of an overwhelming number of patients to a limited number of doctors, which may potentially pose a problem for North Carolina. However, the FutureDocs tool can accurately evaluate the number of available physicians and their specialties of any particular local to even national area. The tool also accounts for differing variables that may occur, including situations like expansion of Medicaid.

Assistant Professor in Family Medicine at the UNC School of Medicine and leader of the team that developed the tool, Dr. Erin Fraher, describes what the program is and how it was designed for anyone to access and use.

“The FutureDocs Forecasting Tool is an interactive, web-based tool that gives better information about what health workforce shortages might exist in the future,” says Dr. Fraher. “It’s innovative, new, and different because we actually created a tool that you could access yourself online and you can create your own customized visualization. Fundamentally, this tool is different because most past workforce models have started with the question of how many doctors are we going to need; we started with the question of what are the patients’ needs for healthcare, and what different configurations of physicians might be able to meet those needs.”

From the model and forecasting that has been developed for this tool, Dr. Fraher says that the national issue is not the lack of doctors, but what kind of doctors there are.

“The key message from our findings is that everyone is talking about national shortages of upwards of 130,000 physicians, and in fact, our model shows that overall the workforce nationally and in North Carolina is in balance,” says Dr. Fraher. “The main issue is one of distribution. We don’t have physicians in the right places, and we don’t have them in the right specialties.”

For the past three years, Dr. Fraher has worked alongside a team of specialists to make this tool a reality, including economists, workforce planners, cartographers, web developers, and more.

“We as workforce researchers got tired of looking at workforce models that came out with the answer,” says Dr. Fraher. “People need to think and move beyond the idea that there’s one answer. This health system is changing so quickly that we need a model that accounts for different scenarios that might happen.”

While there are parts throughout the U.S. that fear that they are lacking in the number of necessary doctors, Dr. Fraher says that North Carolina is doing well and is currently evenly balanced, particularly in the Triad region of the state. While she says there does appear to be signs of a red flag with the probable decline in capacity to provide circulatory doctors as well as the often-flexible internal medicine physicians, there is healthy growth in the number of internal medicine specialties, such as endocrinology.

“The idea is that people need to use the tool to counter some anecdotal evidences out there,” says Dr. Fraher. “We keep hearing that the expansion of Medicaid would cause a shortage; not really, is what our model is saying.”

When it comes to making a change uin the presence of physicians throughout the country, Dr. Fraher says that we need for doctors need to focus on general medicine rather than specializing and to spread training out to more areas.

“We have a mal-distribution of physicians and we also have a mal-distribution of training, and those places that have more physicians have more training,” says Dr. Fraher. “We really have got to think about getting training decentralized, out into communities that need physicians. We also need to think about trying to get general internal medicine residents to stay in general internal medicine.”

The FutureDocs tool is a program that is designed for everyone to use, and for Dr. Fraher and her team, that means even those that have the power to decide where healthcare practitioners should be distributed and. She says she wants this program to create a broad and lasting impact on how the workforce is structured for the future.

“We hope that health systems and others will use the data to help figure out innovative ways that they might configure their workforce,” says Dr. Fraher. “We want to give people the data they need to redesign the way they are delivering care and have the information they need to know what’s coming down the pike for them.”

For more information and to use the FutureDocs Forecasting Tool for yourself, click here.

Medicaid Advocates Hold Press Event in Raleigh

Advocates for expanding Medicaid in North Carolina scheduled a press conference earlier this afternoon at the Legislative Building in Raleigh.

The event was organized by a coalition of organizations that represent and serve aging North Carolinians.

The $21.1 billion budget, passed through Senate shortly after midnight May 31, proposed cuts to insurance coverage for the elderly, blind and disabled.

Proposed cuts include removing 12,000 people from the Medicaid roll, denying eligibility to North Carolinians in adult care homes.

Those numbers come from AARP’s Associate State Director for Advocacy, Mary Bethel. She planned to attend the press conference and told WCHL the conversation will be centered on the concern of some of the “state’s most vulnerable citizens.”

“To qualify for Medicaid in North Carolina as an aged, blind or disabled individual, your income can be no higher than 100 percent of federal poverty levels,” Bethel says. “Health care costs can be very significant to an older or disabled individual and certainly they need Medicaid to not only get the health care they need to maintain their well-being.”

The budget also includes a $1 million cut to the Home and Community Block Grant, which assists the elderly in staying in their own homes through programs that provide food deliveries, in-home aid and transportation assistance.

Boasting an ever-expanding waitlist of over 16,000 people, the grant will have to be cut by almost 1,500 people who are already receiving outside aid.

Scheduled speakers included the President of the N.C. Coalition on Aging, Kate Castillo, President of the N.C. Association of Area Agencies on Aging, Joan Pellettier, and various representatives from nearly 30 organizations.

Gov. McCrory: Fix Medicaid First, Agree To Disagree, And Against Shutdown

CHAPEL HILL – Your Governor, Pat McCrory, joined Ron Stutts by phone on the WCHL Friday Morning News to talk about Medicaid, Moral Mondays, and the government shutdown.

***Listen to the Interview***

NC Legislature OKs Personal Care Service Change

RALEIGH, N.C. (AP) – A way to restore more Medicaid-funded assistance to people in North Carolina with dementia or Alzheimer’s disease has received final legislative approval.

Governor Pat McCrory next receives the legislation that got the General Assembly’s last formal OK Tuesday.

The legislation creates a way people with these conditions – either living at home on in special care units – to receive up to 130 hours monthly in personal care services, such as getting dressed, bathed and fed.

The state reduced care for these people to 80 hours per month this year to comply with federal requirements that services be comparable at home and in corporate settings. Special care unit operators were concerned about the fewer hours.

The bill says personal care reimbursement rates will be reduced to pay for broader coverage.

NC Medicaid Shortfall Now $330 Million-Plus

RALEIGH – The North Carolina office that oversees Medicaid says the funding shortfall for the government health insurance program is more than $330 million.

Health and Human Services Secretary Aldona Wos said Tuesday the shortfall has grown $85 million above the $248 million projected by Gov. Pat McCrory’s administration earlier this month.

Wos’ office again blamed the expanded shortfall on then-Gov. Beverly Perdue’s administration – this time saying it overestimated Medicaid receipts. McCrory’s agencies attributed an earlier shortfall uptick to a forecasting model error last year.

A bill in the General Assembly would give McCrory access to $400 million in unspent funds, cost savings and surplus tax collections to cover the shortfall. But that money is also supposed to cover $118 million for an outstanding drug rebate to the federal government.

Medicaid and Medicare Myths

In the face of all the budget cuts for both state and federal I thought some interesting facts and statistics would put our “state of Medicaid and Medicare” in perspective. The bill recently approved by the U.S. House of Representatives would cut federal Medicaid spending by 50% by 2030.
Medicaid Facts
  • It is funded jointly by state and federal governments, with the federal government’s share ranging from 50% to 80%.
  • Over 15% of seniors rely on Medicaid, all of whom are poor.
  • Seniors and people with disabilities comprise 1/3rd of Medicaid recipients, but account for 2/3rds of the costs.
  • Medicaid is primary payor for long-term care.
  • 1/3rd of total Medicaid spending supports 2.8 million people through home and community-based services (HCBS) and 1.7 million nursing home residents.
  • 7-out-of-10 people over 65 will need long-term care at some point, and nearly 10,000 baby boomers turn 65 every day.
On top of these facts about Medicaid, here are a few compelling facts about Medicare:
  • According to the figures presented by Dr. Tricia Neuman of the Kaiser Family Foundation at the LCAO event, half of all Medicare recipients live on incomes of less than $22,000 a year, with less than $2,100 in savings accounts and less than $31,000 in other assets.
  • Projections show that about half will have incomes less than $27,000 by 2030.
  • The need is growing as seniors and people with disabilities live longer.
I am interested in your thoughts on aging Americans in our country and our “state of Medicaid and Medicare”. 
Tell us your Comments!