A portion of North Carolina’s Medicaid population won’t shift to managed care coverage this fall due to the extended state budget stalemate, the Department of Health and Human Services announced on Tuesday.
Managed care was supposed to go online for Medicaid enrollees in 27 northern counties on Nov. 1, with the rest of the state phased in on Feb. 1. But without funds to cover the transition and final changes needed to set rates for health care entities providing coverage, the first batch of counties can’t move forward that quickly, DHHS Secretary Mandy Cohen said.
“Without a new budget … we do not have the ability to go live with managed care,” Cohen said. Managed care services are now scheduled to begin in all 100 counties on Feb. 1. Cohen suggested the updated rollout schedule could be revisited again if a budget isn’t worked out by mid-November.
The updated managed-care language was contained in the budget bill, but Democratic Gov. Roy Cooper vetoed the bill in late June, in large part because it lacked Medicaid enrollment for hundreds of thousands of additional adults through the 2010 federal health care law.
Republican lawmakers last week sent him a stand-alone measure containing similar Medicaid managed-care provisions, but he vetoed that too, citing health care as “an area where North Carolina needs us to do more, and to do it comprehensively.”
Starting with a 2015 state law, Medicaid is moving from a traditional fee-for-service model to one in which four private insurers and a physicians’ partnership awarded contracts by the state will receive fixed monthly payments for every patient seen. About 1.6 million of the 2.1 million Medicaid enrollees in North Carolina will participate for now. Health officials say the changes should lead to improved health outcomes and more fiscal stability for Medicaid, which spends about $4 billion in state tax dollars annually.
Cohen, a Cooper appointee, said even if the governor had signed last week’s bill, there wouldn’t have been enough time to get everything in place for a Nov. 1 rollout. And the general budget uncertainty this summer already had slowed down her agency’s work to finalize contracts with health care providers, she said.
When Cooper vetoed the Medicaid bill last week, Republican legislators said the governor was letting his demand for expansion get in the way of carrying out needed Medicaid reforms.
Cohen acknowledged that bringing all 100 counties online at the same times increases the risk for operational problems that the original phase-in could have possibly avoided.
Medicaid recipients in the 27 counties — stretching from Boone to Rocky Mount and including the Triangle and Triad — will be contacted about the delay. Open enrollment — when enrollees can choose which health plan they’ll use — in those counties will now continue until Dec. 13, when enrollment in the other counties also will end. Enrollment in the 73 counties begins Oct. 14.
Related Stories
‹

North Carolina’s New Governor Seeks More Helene Aid, Help for Families in Legislative AddressWritten by GARY D. ROBERTSON RALEIGH, N.C. (AP) — New North Carolina Democratic Gov. Josh Stein gave his first address to a joint General Assembly session Wednesday night, hitting on familiar campaign and early-term themes of helping Hurricane Helene victims, making living expenses affordable and focusing on bipartisan accomplishments. Stein delivered the biennial State of the State […]

Extra Private School Voucher Funding Gets Initial Ok From North Carolina SenateThe North Carolina Senate took the first step in clearing the waitlist for private school vouchers after passing a supplemental spending plan.

All Qualifying North Carolina Hospitals Are Joining Debt-Reduction Effort, Governor SaysAll qualifying North Carolina hospitals have agreed to participate in the first-of-its-kind initiative aiming to reduce medical debt.

US Regulators OK North Carolina Medicaid Carrot to Hospitals To Eliminate Patient DebtFederal regulators signed off on a proposal to offer scores of North Carolina hospitals incentives to eliminate patients' medical debt.

Cooper, Medicaid Leader Push Insurance Enrollment as North Carolina Medicaid Expansion Also GrowsWritten by GARY D. ROBERTSON North Carolina is barely a month into the start of Medicaid expansion in the state and over 310,000 low-income adults have now enrolled in the government health care coverage, Gov. Roy Cooper said Wednesday while hosting the nation’s chief Medicaid regulator. The Democratic governor joined Chiquita Brooks-LaSure, administrator of the Centers for […]

North Carolina Medicaid Expansion Still Set for Dec. 1 Start as Federal Regulators Give Final OKWritten by THE ASSOCIATED PRESS Federal regulators have given their final approval for North Carolina to begin offering Medicaid to hundreds of thousands of low-income adults on Dec. 1, state health officials announced on Friday. The Centers for Medicare & Medicaid Services told the state in a letter Thursday that changes to North Carolina’s Medicaid program to provide […]

Republicans Ditch Efforts to Expand Legal Gambling in North Carolina, Will Pass Budget This WeekWritten by GARY D. ROBERTSON North Carolina Republican legislative leaders ditched late Tuesday efforts this year to dramatically multiply legal gambling in the state, announcing instead that they will pass a final budget without it that also would trigger Medicaid coverage to begin for hundreds of thousands of adults. “We think this is the […]

Medicaid Expansion Won't Begin in North Carolina on Oct. 1 Because There's Still No Final BudgetWritten by GARY D. ROBERTSON With the state budget’s passage now two months late, North Carolina Gov. Roy Cooper’s administration announced Monday that it can’t start the implementation of Medicaid expansion to hundreds of thousands of low-income adults in the early fall as it had wanted. State Health and Human Services Secretary Kody Kinsley said that […]

North Carolina’s Governor Visits Rural Areas To Promote Medicaid Expansion Delayed by Budget WaitWritten by THE ASSOCIATED PRESS With a Medicaid expansion kickoff likely delayed further in North Carolina as General Assembly budget negotiations drag on, Democratic Gov. Roy Cooper wrapped up a week of rural travel Thursday to attempt to build pressure upon Republicans to hustle on an agreement. Cooper met with elected officials and physicians in […]

As NC Waits for Medicaid Expansion, Federal Provision Could Leave Some in Coverage GapNorth Carolina lawmakers came to an agreement to expand the state’s Medicaid services. But a recent change may leave some in a healthcare gap.
›
Comments on Chapelboro are moderated according to our Community Guidelines