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Since assuming office Gov. McCrory has throttled the theme that Medicaid is broken and must be reformed. He began by offering a radical proposal of dismantling our current system and selling it off to private insurance plans. He has since backed away from that idea and now wants a more modest expansion of what currently works in Medicaid.

The House, in a bipartisan bill filed this session, clearly agrees with the Governor’s new approach. The legislation, spearheaded by Rep. Nelson Dollar, would build Accountable Care Organizations (or ACOs)  in Medicaid. These provider led ACOs would move us toward greater integration of care and away from fee-for-service medicine. Medicare is using the ACO model as are many private insurers. In fact, Medicaid is one of the only payers in the state not moving to this method of organizing care.

In its budget, the Senate flatly rejects this approach. That chamber wants Medicaid to move to full capitation. In other words, legislators want to provide a set budget to Medicaid. The insinuation is that the Senate prefers the Governor’s original plan to pay private insurers to care (or not care, as the case may be) for our most vulnerable citizens.

The Senate also engages in some fantasy by pulling Medicaid into a freestanding department that will engage the nation’s best health care minds in this ambitious reform effort. At least that’s how Sen. Louis Pate described the proposed process. The trouble, of course, is that the nation’s best health care minds consider North Carolina’s Medicaid program to be an important model and they aren’t interested in helping to dismember it. The nation’s best health care minds also aren’t interested in coming to our state and spending time tearing apart care for low-income people as the legislature reduces services, limits eligibility, and slashes the budget. We are, in short, engaged in the opposite of innovation.

Rep. Dollar is a smart chap and likely realizes that his ACO bill isn’t going anywhere as a piece of legislation. That means he will need to stick the proposal into the House budget to give it a fighting chance. Hence, the showdown mentioned in the title of this post.

Certainly the House is moving in a better direction. But it’s a good time to reflect that Virginia is having its own budget battle over Medicaid right now. Except instead of fighting over how to fiddle with (or blow up) a program that is working, Virginia’s leaders are having a serious discussion about using federal funds to expand Medicaid coverage to 400,000 people. If that happens it means that our tax dollars will help boost Virginia’s economy, bolster its rural hospitals, and support its citizens.

That will certainly be charitable of us, but not wise.

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Pat McCrory 2It’s good to know that while things are going to hell in a handbasket during the busiest time of the year in the state capital, North Carolina’s fearless leader will be right in the mix doing what he almost always does on Friday — scheduling “official” events in Charlotte so that he can spend the weekend in his actual home. Today — and we’re not making this up — it’s a doggie photo shoot.

Here is the Guv’s official schedule for today: Read More

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Last October Gov. McCrory caused a stir, and raised some eyebrows, when he said that the state may be forced to expand Medicaid due to a “new” regulation.

The policy to which he was referring is called presumptive eligibility. Presumptive eligibility allows states to give permission to hospitals and other providers to temporarily enroll certain people in Medicaid. North Carolina, for example, allows presumptive eligibility for pregnant women. That means if a hospital does an initial check and it looks like a pregnant woman is likely to qualify for Medicaid then the hospital can temporarily enroll her and get paid for the services it provides. Meanwhile, an application for full Medicaid can be processed without a disruption in care.

This policy is critical for ensuring that patients get care and providers get paid.

In states with efficient systems that can process Medicaid eligibility in real time, this temporary measure is not as important. In states where parents are having to ration medicine for their children due to a backlog in processing Medicaid applications, presumptive eligibility is a critical tool.

Health reform gave hospitals more latitude to presumptively enroll patients, even if the state has not granted the hospital permission to participate in the program. Other providers, notably Community Health Centers, however, are still not able to use presumptive eligibility to enroll children in Medicaid. The Community Health Centers are still limited to enrolling pregnant women.

Ultimately, the state needs to fix its computer system. In the meantime, we need to get care to children. We could start by granting Community Health Centers, and possibly other providers, the ability to temporarily enroll likely eligible kids in Medicaid while DHHS clears its application bottle neck.

And until the state expands Medicaid to all low-income people we will need every splint and bandage we can find to patch our broken system.

 

 

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At a Tuesday morning roundtable sponsored by Dell, Intel and the N.C. Business Committee for Education, Gov. Pat McCrory spoke to educators and business leaders who were gathered at the N.C. Department of Public Instruction to strategize about ways to improve teacher effectiveness and next generation learning.

Using the opportunity to reiterate his education goals for the upcoming legislative session, which include paying all teachers more, McCrory hammered home his idea to create a “career pathway plan.”

“We want to ensure teachers have a career…and not a temporary stopover,” said McCrory, explaining that currently teachers have no way to move up in their profession unless they move into higher-paying administrative roles – a career move that not all practitioners are interested in making.

In addition to proposing a two percent average pay increase for all teachers and paying beginning teachers even more, McCrory proposed last week to create a long-term plan that would entice more teachers to stay in the profession by seeing salary increases that are linked to their work as teachers.

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Pat McCrory 4Dan ForestWith yesterday’s mostly predictable election out of the way, state policy debates will actually take center stage in North Carolina for a few weeks. Not surprisingly though, the process will begin today with a rather strange pair of competing press conferences in which the ideological battles that played out in the Republican Party primary between the far right and the ultra-far-right will be renewed. As WRAL.com reported last night:

“Gov. Pat McCrory said Tuesday that he plans to roll out a ‘major education announcement’ in Greensboro on Wednesday that will address long-term issues and focus on rewarding teachers for good work….

The governor plans to join educators, state and local officials and business leaders at North Carolina A&T State University for the 10 a.m. announcement.

Four hours later, Lt. Gov. Dan Forest will join Sen. Jerry Tillman, R-Randolph, chief education budget writer in the Senate, in Raleigh to ‘unveil a new fund to supplement teacher pay in North Carolina public schools.’

Talk about the right hand not keeping up with the left (or, in this case, the right hand not keeping up with the extreme right). Of course, it’s been common knowledge in Raleigh for a long time that Forest is the darling of the Tea Party/religious right crowd and that he has been building a network of supporters to help him run for Governor in 2020 (or maybe even 2016 if McCrory continues to falter). Could it be that the contest between these two will begin today with, ironically enough, competing proposals over teacher pay — a subject over which the GOP has been pummeled for its budget-slashing policies? Stay tuned — it could be that an interesting next chapter in state policy wars is about to begin.