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MedicaidAs Governor McCrory and his HHS Secretary Aldona Wos convene a rather strange closed door “listening  session” on Medicaid in Greensboro today (it’s scheduled to last all of 45 minutes), let’s hope they both took the time over the weekend to read an excellent, “from-the-trenches” essay by Goldsboro physician Dr. David Tayloe in Raleigh’s News & ObserverIn it, Tayloe explains the importance of preserving and improving North Carolina’s homegrown “medical home” model for delivering Medicaid services (Community Care of North Carolina) rather than falling for the false promises of out-of-state HMO companies that have been trying to muscle their way into the state.

CCNC is rooted in care coordinated by providers, not insurance corporations. By keeping care decisions in the hands of those most qualified to make them, medical home models improve health outcomes for North Carolina’s Medicaid population. Doctors, care managers and pharmacists across provider-led networks share data and best practices to provide efficient and high-quality care to patients, decreasing emergency room visits and reducing wasteful spending.

The CCNC model is the result of decades of work that has consistently generated positive results in North Carolina. An HMO takeover of this system would mean higher administrative costs to the state and billions of taxpayer dollars leaving the state to pay corporate shareholders. Under federal Medicaid rules, the additional money required to pay HMOs can come from only one place – sharp cuts to provider payments. When physicians choose not to participate in Medicaid, patients neglect preventive care and head to the emergency room in crisis, raising state costs while producing less positive health outcomes. Read More

MedicaidThere’s new and compelling evidence that North Carolina’s model for delivering Medicaid (Community Care North Carolina -CCNC) is a winner — notwithstanding the often-bumbling oversight provided by embattled state DHHS Secretary Aldona Wos and the attempt by Senate leaders to sell the program off to a private managed care company. (It’s worth noting that the flawed sell-off idea was once also touted by Gov. McCrory and Sec. Wos as well until the two gradually came to their senses over the past year).

Today, in a letter to state Medicaid directors throughout the country, the Centers for Medicare and Medicaid Services at the national DHHS announced today that they are launching a new national collaborative initiative called the “Medicaid Innovation Accleerator Program.” The goal of initiative is “to improve care and improve health for Medicaid beneficiaries and reduce costs by supporting states in accelerating new payment and service delivery reforms.”

The letter announcing the initiative holds up three examples of state innovation success in Ohio, Washington and North Carolina. Here’s what it has to say about North Carolina: Read More

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

030910_1603_HealthRefor1.jpgIn case you missed it, there’s been a very worrisome outbreak of the deadly infection known as Legionnaire’s Disease in Wilson County with at least 11 individuals contracting the disease. Unfortunately, as today’s editorial in the Wilson Times notes, the response of the North Carolina’s Department of Health and Human Services (and its policies for notifying the public do not appear to be up to snuff):

“Since earlier in June the number of cases in Wilson went from one to 11 and from one location to more. Last year 12 percent of all the Legionnaires cases reported in the entire state of North Carolina were in Wilson County.

We commend our local Department of Health for reacting quickly to the early reported cases and getting the word out to the public as quickly as possible. Wilson Pines, where most of the cases have been linked, was also quick to take action.

However, the N.C. Department of Health and Human Services doesn’t seem to have responded with the same sense of urgency. It received its first confirmation of a Legionnaires’ case back on June 19 at the state-run Longleaf-Neuro Medical Treatment Center.

At that point it was just one known case there and apparently policy is to not declare an outbreak until you have two confirmed cases at one location. The state didn’t get that second report until last Friday, June 27, letting the public know via press release on Saturday.

Read More

In a good conversation with Becki Gray yesterday on News 14 we discussed the different visions for Medicaid reform proposed in the respective budgets of the Governor, House, and Senate. In particular, Gray, who works for the John Locke Foundation, noted that the state has a “rich” benefits package in Medicaid because we offer many optional services, that is, services that are not required to be covered by the federal government. The Senate, she correctly pointed out, wants to whittle away these optional services.

Ending optional services in Medicaid is a popular policy among conservative think tanks in the state. Apparently the Senate is listening.

As this debate progresses it is important that we know what services we are talking about when we talk about optional services. Let’s review a few: transplants, prescription drugs, dentures, hospice, prosthetics. None of these treatments are frivolous or lavish.

And that’s the trouble with optional services. If you want to get at some of the more expensive options then you are limiting life-saving care. Former Locke Foundation analyst Joe Colletti even praised Arizona for cutting optional services like transplants in a report on Medicaid reform. But these cuts inflicted so much pain in Arizona that the state made a volte-face on its decision.

That brings us to the Senate budget. Among other things the Senate wants to end the optional Medically Needy program in Medicaid. This program allows people who have enormous medical expenses, but earn too much to qualify for Medicaid, to apply these medical bills to their income to access Medicaid. This makes sense. If, for example, you earn $30,000 per year but need expensive drugs or nursing home care then these costs will quickly eat through your monthly income. Although you may have some money your medical needs erase it all. It’s not fair to tell this person that he or she is too wealthy for Medicaid when they effectively have nothing.

But this is exactly what the Senate aims to do.

As we have said many times before, “optional” refers to a regulatory requirement and does not mean anything about the necessity or quality of specific Medicaid services. You may call it foolish for the state to cover optional services. I call it basic human decency.