Column sets the record straight: Medicaid not broken

In case you missed it over the weekend, check out Ned Barnett’s column from Raleigh’s News & Observer entitled “Truth gets stretched in Medicaid debate.”

As Barnett notes: the myth being propagated by Gov. McCrory and the General Assembly (with the unfortunate assistance of the politically tone deaf state Auditor) that Medicaid is “broken” and therefore can’t be expanded under Obamacare is just plain baloney.

“The reason DHHS’ Medicaid spending continues to be over budget is because the Republican-controlled legislature reduced its budget without defining what to cut, such as payments to doctors and hospitals, services offered or the number of people eligible. Apart from missing the General Assembly’s unrealistic savings targets, Medicaid delivery systems in North Carolina are very much intact. From 2007 to 2010, Medicaid spending in North Carolina grew more slowly than in any other state in the nation. One of its delivery models, Community Care, is a widely praised prototype for cost savings that other states want to copy. No doubt, a state division spending $13 billion in state and federal funds annually has things that could be fixed, but it clearly is not ‘broken.'”

Read Barnett’s entire column by clicking here.


  1. Charlie

    February 18, 2013 at 9:31 am

    Let’s not forget that NC’s decision to implement a MH/DD/SA carve-out under the Medicaid Waiver has created an enormous layer of purely administrative Local Management Entities. The implementation of Medicaid managed care for behavioral health services in NC has devastated care provision and siphoned off untold millions. It has created a monopsony over behavioral health services in NC. Strangely though, these issues are hardly, if ever, mentioned. It seems that MH/DD/SA services in NC are the sacrificial lamb that no one wants to save.

  2. Jack

    February 18, 2013 at 9:56 am

    Broken is GOP code for “we are going to kill Medicaid” our at least give it a go because we want to prove that all of government is broken.

    As the article says, the system isn’t broken but the GOP will talk it up as if it is and there will be those who will accept their word for it.

    Creating a broken government is the GOP’s way of getting what they want, and what they want is a downed sized government catering to the the few while turning its back on the many.

    The GOP is a mass of angry men and women who are out to get their pound of flesh many times over. They will not stop until they have dismantled the government and left it whimpering by the roadside. They’ve made this clear not just in their to-the-bone-budget-cuts but by word and other deeds. We are witness to the ongoing drama of 12 Angry Men/Women squared.

    And by the way, in case you’ve forgotten, the correct name is the “Affordable Care Act”. The other name is dismissive of a worthwhile and necessary program from which the people will benefit.

  3. MST

    February 18, 2013 at 10:11 am

    @Charlie I’m lost: MH/DD/SA carve-out under the Medicaid Waiver… Local Management Entities…
    siphoned off untold millions …Which side of the Medicaid expansion issue are you on, I’m not familiar with your terminology, or the policy, but I surely know the sorry state of mental health care services in NC for the uninsured (or the insured, for that matter). Not that there aren’t good people among the professionals, if the system worked.

  4. david esmay

    February 18, 2013 at 10:17 am

    Charlie and Jack, great posts. One thing I’d add Jack, the oft repeated mantra of the Right that something is “broken” points to two things, the first being the reason the GOP uses this tactic is because they elect people too incompetent to govern. The second is using this as a method in which they try to avoid taking responsibility for their own culpability and as an excuse for inaction.

  5. Alex

    February 18, 2013 at 10:30 am

    david seems to forget Democrats have been blaming Republicans for the last five years, and have never “owned” their misguided economic policies which have punished the middle class and created massive debt.. Talk about calling the kettle black !

  6. Jack

    February 18, 2013 at 11:12 am


    That was then this is now, and now is what matters.

    You make it sound as if the GOP now has the right to dismantle our government and throw countless lives of NC citizens into the unknown because of what you believe the Dems. did back when.

    Your thought only confirms my statement that “The GOP is a mass of angry men and women who are out to get their pound of flesh many times over,” at the expense of the people.

    The GOP isn’t governing and therefore is not representing the people above its self-interest.

    What we the people are witness to is the GOP slashing and burning its way through state government for the purpose of creating greater fear, hate, discrimination, isolation and class warfare.

    It is clear that the party of Lincoln is no more.

  7. Charlie

    February 18, 2013 at 1:40 pm

    @MST: I suppose you could say I’m on the side of doing what’s in the best interest of NC’s healthcare providers and consumers. Here’s a bit more detail… NC obtained a Federal Medicaid Waiver for behavioral health services and began implementation with one pilot site in 2005. What the waiver does is allow NC to literally “waive” 2 key provisions of the Social Security Act. These are the right of medicaid recipients to choose “any willing and able provider” and the right to services that are equal to those obtained by the privately insured. So now NC has been transforming the Local Management Entities (LME) across the state to Medicaid Managed Care Organizations (MCO). The local management entities now becoming MCOs control all Medicaid funding for mental health, developmental disability, and substance abuse services in NC. They also control 100% of the utilization of that money. In other words, they pay private providers IF they decide the medicaid recipient needs those requested services. HUGE amounts of money have gone into developing this layer of pure administration… all under the guise of keeping those “unscrupulous” providers from bilking the State out of Medicaid money. This is a complete farce. NC got taken for about 400 million in medicaid funds prior to the beginning of reform because the powers that be in Raleigh opened the doors wide, with few checks and balances, for sketchy providers to come in and take advantage of the program. In retaliation, NC began hacking and slashing away at MH/DD/SA budgets and providers across the State… 99% of whom had absolutely nothing to do with the prior Medicaid fraud. They implemented the LME system to serve literally as “big brother” watching over providers. All of this under the idea that NC was creating a better system for consumers and would save money. But, no one seems to talk about what all these changes cost or how much the LMEs have squirreled away. In one report from June 2010, the LMEs cumulatively held 600,000,000 in their fund balances. Where did that come from? Since then many LMEs have stopped publishing their board minutes, have pushed to be exempt from public records laws, and have been the target of lawsuits alleging inappropriate and unwarranted denial of services to consumers. What most people don’t know or try to deny is that this is not NC’s first foray into Medicaid Managed Care. In the mid 1990s, NC implemented a Medicaid Waiver program called Carolina Alternatives in select counties across the State. It looked very much like what we have today and suffered the same problems. This was a waiver pilot program and it was such a failure that it became, at that time, the only Medicaid Waiver program in the Nation to be revoked by the Federal Government.

    So… I support the ACA but I vehemently oppose carving out MH/DD/SA services.

  8. david esmay

    February 18, 2013 at 1:45 pm

    Own the recession Alex, own it. Alex, you and the rest of your brethren on the Right act as if the GOP didn’t exist before 2009 and governor bush didn’t exist at all. The fact is the GOP has controlled the House for 18 of the last 22 years. David Stockman and Bruce Bartlett have admitted that GOP economic policies have been an unmitigated disaster, recent history and evidence supports the fact that Republicans know little of economics and have proven to be fiscally irresponsible.

  9. Charlie

    February 18, 2013 at 1:54 pm

    All I really want to know, and no one seems to be willing or able to answer this, is how much did the NCGA’s decision to implement the MH/DD/SA waiver Statewide impact the Medicaid budget? How much did it impact the State budget overall? Maybe I’m wrong but it seems like the dumbest time possible to be developing a totally new Statewide administrative infrastructure.

  10. Charlie

    February 18, 2013 at 2:01 pm

    Lastly, I wholeheartedly support medicaid expansion. But let’s put everything under one roof and have a truly unified system. All one has to do to see that the MH/DD/SA carve out is a bad thing is look next door to Tennessee. TennCare is a nightmare… just ask the recipients or any providers.

  11. Jack

    February 19, 2013 at 9:10 am


    I’ve watched this take place by attending the Statewide CFAC meetings. The Division thinks that it is doing a great job but it is clear during such statement that they are talking out the side of their mouths.

  12. Charlie

    February 20, 2013 at 11:48 pm

    Thanks Jack. I’m still trying to figure out how much the NCGA’s decision to implement the Medicaid waiver Statewide has impacted the Medicaid budget. I suppose it’s possible that it hasn’t impacted it at all… if that’s the case then from where, exactly, did the money come? Why isn’t anyone asking this question? If the NCGA blew the budget in part because they implemented a MH/DD/SA system that has truly made NC one of the worst States in the US for behavioral healthcare, wouldn’t that qualify as news? Thanks again Jack!

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