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The head of North Carolina’s troubled health and human services department told lawmakers Tuesday that moving the Medicaid program out from under her purview to a stand-alone agency would “be against common sense.”

“Absolutely not,” said N.C. Health and Human Services Secretary Aldona Wos in a response to a question about whether moving the $13 billion Medicaid outside of her domain would make things easier on the agency.

“To separate parts of [DHHS functions] out to the department will actually go backwards,” she said.

DHHS Sec. Aldona Wos

DHHS Sec. Aldona Wos

Wos made her comments Tuesday at a legislative oversight committee hearing. It also comes as lawmakers consider whether to embark next year on an ambitious plan by Senate Republicans to move the state’s Medicaid program to a standalone agency reporting jointly to the governor and state lawmakers.

A special program evaluation committee recently formed to consider different scenarios for Medicaid, an entitlement program that provides health care for the poor seniors, children and disabled residents, is funded through a mix of federal and state dollars.

Lawmakers have for years voiced frustration with faulty budget forecasts and unexpected cost overruns within the Medicaid program. Several Republican politicians — including legislative leaders and Gov. Pat McCrory — have held up the forecasting roblems as reason why North Carolina should not expand its Medicaid program, a move that would tap federal money to provide healthcare for an estimated 400,000 North Carolinians unable to afford their own insurance.

Wos, a Greensboro physician and wealthy Republican fundraiser appointed by McCrory to lead the state’s largest agency in January 2013, had plenty of other tough topics to cover with Tuesday’s legislative oversight committee. The tense reception has become a routine scenario for Wos as she’s grappled with negative coverage over high-dollar personal contracts and raises for close associates, as well as major disruptions in the state’s Medicaid billing and food stamp dispersal systems.

On Tuesday, Wos and her staff faced questions about a $6.8 million no-bid contract given to a consulting firm Alvarez & Marshal to advise and manage the Medicaid program.

Wos told lawmakers that she needed to hire the firm because she didn’t have any staff able to manage the program properly as she and other agency staff were developing a comprehensive Medicaid reform plan.

“We had an emergency,” Wos said. “We had to figure out how to get our daily work done.”

State law requires most contracts to go through a bidding process, in order to keep costs down and to allow for competition in lucrative contracts. Wos credited the consulting firm’s work with allowing the Medicaid program to meet its budget this year, and return $63 million to the state’s general fund.

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The N.C. Department of Health and Human Services announced this afternoon that an architect of a stalled Medicaid reform plan is leaving the state agency.

Margaret “Mardy” Peal, 43, was hired in August 2013 by Health and Human Services Secretary Aldona Wos despite having been out of the work force for more than a decade, according to a News & Observer article published shortly after Peal’s hire.

The job was not posted, and was a newly created position to look at privatizing the state’s complex $13 billion Medicaid program, which is funded with a mix of state and federal dollars and provides health care for low-income children and their parents, seniors and disabled residents.

Peal, who has a master’s in health education and lectured at East Carolina University’s medical school on patient care in the late 1990s, had donated $1,250 to Gov. Pat McCrory’s campaign, according to the N&O article. She also organized the Eastern North Carolina chapter of the Tea Party.

She made $95,000 a year in her DHHS position to help the agency develop a reform proposal for the state’s $13 billion Medicaid program. Peal’s hire last year came while Wos was facing criticism for giving big raises to several inexperienced McCrory campaign staffers.

The agency, at the urging of doctor and other medical provider groups, ultimately proposed parceling out Medicaid health care responsibilities to accountable care organizations (ACOs) around the state but the agency plan failed to get the backing of leading Senate Republicans who wanted to take Medicaid out from under DHHS and open it up to bids from managed care companies.

In a statement, state Medicaid Director Dr. Robin Cummings thanked Peal for her work and emphasized that the state agency planned on pursuing its approach to Medicaid reform.

“Working with doctors, hospitals and other healthcare providers and stakeholders across the state, DHHS will continue to pursue our Medicaid Reform plan,” Cummings said, according to a written statement.

In her Aug. 25 resignation letter (click here to read), Peal wrote that she was grateful for the experience working at DHHS but an unspecified opportunity in the private sector would allow her to spend more time with family.

“At this point in my family’s life, it is necessary that I spend a greater percentage of my time with them,” Peal wrote. “An opportunity presented itself that would allow me more time at home, and I have chose to pursue it.”

 

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Medicaid 3As state lawmakers and Gov. McCrory argue about ways to cut public outlays for Medicaid — the public health insurance system for people of low income — the lead editorials in North Carolina’s two largest newspapers offer some straightforward and compelling truths this morning that ought to guide their discussions:

1) Service cuts harm real people in need and 2)  Things ain’t gonna’ improve as long as Dr. Aldona Wos runs the show.

As Raleigh’s News & Observer reminds us, when legislators cut services to save money (even though, as the editorial notes, per person costs are down and quality of service is up) they make life hell for people like Mason Leonard and his mom Colleen:

“Mason Leonard, 14, of Cary is severely disabled. He was brain-damaged at birth and cannot care for himself. He can’t be left alone, can’t feed himself or look after any of his needs.

But thanks to a few Medicaid services, he receives therapy, gets out a little, gets trained in things like making his bed, which, when he accomplishes it, is considered a big step….

A Medicaid policy change last year, for example, eliminated weekend hours for teaching Mason how to function with basic skills. His mother understandably fears what new hardships further “reform” will produce.

Here is what the public needs to understand about the budget cutting and reform conducted under the banner of ‘efficiency.’ For each cut, for each decision to eliminate some benefit, a disabled person such as Mason Leonard or a poor person with no alternative for care except what Medicaid provides and their caregivers and family members suffer discomfort or pain.”

And then there’s this bit of plain truth from the Charlotte Observer: state Health and Human Services Secretary Aldona Wos simply has to go. As the Observer notes: Read More

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The N.C. Department of Health and Human Services released a cheerful video this afternoon touting the supposed successes of the state’s new Medicaid billing system that delayed payments for thousands of medical providers for months over the last year.

The nearly 4-minute video produced by state employees includes interviews set to upbeat instrumental music with several providers and DHHS officials talking about how well the complicated Medicaid billing system is working one year after its bungled July 1, 2013 launch.

Much of the system is working now, and providers are getting paid faster than before, DHHS officials say in the video.

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 N.C Tracks replaced the state’s previous 25-year-old Medicaid system and came online despite warnings in a May 2013 performance audit from the state auditor’s office that DHHS hadn’t fully tested the system, left too much up to vendors’ discretion and had no way of knowing ahead of time if the system was ready.

The billing problems have left legislative fiscal research staff without firm budget numbers on the $13 billion program, a major point of contention in the current budget negotiations for Republican state Senate leaders.

Missing from DHHS’ birthday video were some of the choicer statements doctors, lawmakers and others have had about new system and its rollout last year under N.C. DHHS Secretary Aldona Wos.

Here’s a few of the less-than-glowing comments:

  • “NCTracks has made billing go from complex to borderline impossible,” said Sandra Williams, chief financial officer of Cape Fear Valley Health System, at an October legislative hearing.
  • “NCTracks was a disaster, and the State was beyond the point of no return,” lawyers wrote in a lawsuit filed by medical providers in January against the state agency.
  • “We are pretty much in the dark with trying to figure out where we are in the current year,” said Susan Jacobs, a fiscal analyst for the legislature in January about getting budget data from N.C. Tracks.
  • “It’s June 19 and we still don’t have the numbers,” Sen. Tom Apodoca, a Hendersonville Republican, said in a hearing earlier this month about Medicaid budget information, according to the News & Observer. “If push comes to shove, we can always issue subpoenas.”
  • “We are having to manually key claims and do things that before would pay automatically,” Laura Williard of High Point’s Advanced Home Care told WNCN in early June. “At one point, I had 11 temps working for our company to do something that was paid automatically before.”
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Michelle Ford hasn’t received food stamp allotments since December, and the Greensboro mother says she’s out of options in trying to feed herself and her three children.

“We don’t have anything to eat,” Ford said. “This the way it’s been for the last two months, it seems like it’s just getting worse and worse.”

Ford usually receives $692 in food stamps a month to keep her family fed, but her January benefits never appeared. She said she’s neglected paying her light bill, car payment and other bills in order to keep her family fed.

“It’s been horrible,” she said, her voice clenched with tears. Her 18-year-old daughter stays with friends in order to get meals at night and was fired from a job at a McDonald’s stemming over a dispute about food she was taking to share with her family.

Ford’s problems come despite the N.C. Department of Health and Human Services declaring it has “reasonably achieved” an April 1 deadline set by federal officials to resolve a backlog of federally-funded food stamps cases statewide that had been in the tens of thousands for needy families.

A backlog of food stamps cases persisted for most of 2013 in the state when DHHS fully implemented a complicated benefits delivery system called N.C. FAST (Families Accessing Services Through Technology). County-level workers struggled to get the system to work, and cases piled up with some going weeks or months without needed food assistance. ncfast

In Guilford County, where Ford lives, the state discovered in the week before the April 1 deadline that workers had been keeping as many as 8,1000 recertification cases in a separate system then the N.C. FAST benefits delivery system. The head of the county’s social services director resigned shortly after the backlog became public.

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