Medical Society issues scathing takedown of NC Senate Medicaid proposal

MedicaidNorth Carolina doctors pulled no punches in their review of the Medicaid “reform” (i.e. privatization) plan adopted by the state Senate today. This is the official statement from the NC Medical Society:

“Today the Senate had a clear choice between the health of our state’s most vulnerable citizens and the health of Wall Street corporations, and they chose the corporations. Despite strong alternative proposals from the North Carolina House, Governor McCrory and the health care community on the best way to improve patient care and quality and provide budget predictability, Senators voted against this consensus. These outside managed care companies have a dismal history of success (see the examples below). The Medical Society would like to recognize and appreciates the bipartisan support for the consensus plan of the health care community, the House and the Governor today on the Senate floor. It appears that the 28 senators who voted for managed care are not aware or don’t care about the negative history of managed care and are welcoming them to North Carolina.”

For instance,

• Kentucky moved 550,000 of its Medicaid patients to three national managed care corporations in 2011. Since then, a 2012 evaluation by the Urban Institute found that patients faced delays in getting care, and there was an adversarial relationship between the managed care plans and the medical community. State legislators continue to be flooded with complaints and passed a bill to set up an appeals process at the Department of Insurance to mediate disputes between the medical community and the plans. One of the managed care plans pulled out of the state last year, suing the state saying it lost money and forcing 125,000 patients into the other two plans.
• In Illinois, a federal judge awarded over $334 million in a fraud lawsuit against the Medicaid HMO Amerigroup Illinois and its parent company, Amerigroup Corporation, for systematic and extensive fraud for discriminating against pregnant women and those with expensive medical conditions.
• In Georgia, their Medicaid program was fined $3.7 million for consistently refusing to pay for authorized care.



  1. Bobby Poon

    July 25, 2014 at 6:08 am

    Dead on arrival in the house.This is the senate form of Obamacare.It is Bergercare.Death panels and all.Elderly,disabled,poor and those with Alzheimer’s will almost immediately have no funds to stay in special care in assisted living units which are the cheapest and best in the United States..The primary care physicians will shrink from the current 90% to under 10% as the managed care companies will hire them and tell the patient which they must use.Cost will not reduce in the long run,just like Obamacare,as the companies will have to make a profit and it is just one more layer on an already huge bureaucracy out of control.Once the citizens of NC see the harm it is doing to the thousands of poor,elderly,disabled and Alzheimer victims kicked out of assisted living special care homes and the thousands of special care nurses and care units that close and nurses that lose their jobs Tillis will lose his senate seat,the republicans will probably not win the US Senate, and NC will lose at least 8 senate seats.McCrory and Tillis both need to stand up and slap Berger and Hise down hard and show the people of NC just where they stand.The dems are already cutting the ads to make this the main issue this election.Obamacare will not even be the issue if McCrory and Tillis do not come down hard on this and now.

  2. Pertains!

    July 25, 2014 at 7:13 pm

    The Affordable Care Act has nothing in common with what the senate has patched together. The ACA might have a few areas that need adjusting but at least it is PROVIDING care. What the NC Senate wants to do is TAKE AWAY care…..from the less fortunate ones and those who cannot defend themselves.
    They should be ashamed! If they dream of being famous and remembered for leaving NC in better shape than when they started TOO LATE…..vote them out in November!!

  3. Geoffrey Zeger

    July 25, 2014 at 9:18 pm

    It is unclear if the Senate proposal will go through, but as a Direct Enrolled Medicaid Provider working in the Mental Health field, and one who has gone through the implementation of the Medicaid Mangled…sorry…Managed Care system here in NC (otherwise known as the Medicaid 1915 b/c Waiver), it was bedlam. Perhaps the legislature thought ‘you have to break a few eggs to make an omelette’ when they approved it but boy – there were LOTS of broken eggs and it is unclear if there were any omelettes. Now that NC has had its MH/DD/SA services under a managed care system since for a little over one year, it is unclear if there is even a sunny side up. I am still waiting to see if there is outcome data one year post Waiver implementation – are costs down? hospitalizations down? wait times in ER’s down? What is known is thousands of mental health providers stopped taking Medicaid and many others were audited out of existence. What do you think happens to the clients when providers and agencies close? There were several times as the Waiver wave was sweeping through when I had to turn on a dime when an agency closed or dropped Medicaid and refer out clients – many fell through the cracks trying to connect with the new provider. I have many many many stories about the cracked eggs as the Waiver was implemented but suffice to say that if ALL of NC’s Medicaid services have to go through a transition like the implementation of the LME/MCO structure than we can see MANY health care providers stopping accepting Medicaid, businesses closing, and clients having gaps in care. No – this is not hyperbolic thinking – this is a realistic extrapolation based on the real life events that occurred when the mental health system went from fee for service to a Medicaid Managed Care model in 2012. Let us hope that this deform…sorry…reform does not occur and that alternative/cost efficient/clinically appropriate changes are implemented instead.

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