You should read our earlier post about Rep. Nelson Dollar’s excellent objections to Medicaid reform. Dollar deserves kudos for pointing out that our system is not broken.
Despite these objections the legislature is charging ahead. If we want reform, however, the state needs to expand Medicaid at the same time. Why? Because to reform Medicaid we need permission from the federal government. According to the bill passed by the General Assembly we will officially seek this permission from the federal government by June of 2016. The Obama Administration is unlikely to make privatizing our Medicaid program a major priority in its last few months of office. That is not the sort of legacy he is interested in leaving.
If we do not get approval from the current leadership at Health & Human Services then North Carolina will need to wait until a new President takes office. Then the new President will have to nominate an HHS Secretary and we will have to wait for the Secretary to be confirmed. At some point after that HHS will begin to review our reform proposal.
Alternatively, North Carolina could include expansion in the reform plan. Then the Obama Administration would act quickly to approve our waiver. Certainly HHS is not excited about dismantling our model Medicaid system, but they could live with legislative changes if it meant covering 500,000 more people in our state.
With expansion reform will move quickly and our proposed changes will be accepted by HHS. Without expansion reform will be a long, long road to an uncertain destination.