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The House budget includes a requirement that the position of Medicaid Director be subject to confirmation by the North Carolina General Assembly. Here’s some of the language:

4         APPOINTMENT AND CONFIRMATION OF MEDICAID DIRECTOR
5         SECTION 12H.36.(a) Effective July 1, 2014, and applying to Directors of the
6         Division of Medical Services appointed on or after that date, G.S. 108A-54 is amended by
7         adding a new subsection to read:
8         “§ 108A-54. Authorization of Medical Assistance Program; administration.
9         …
10       (e) The Medicaid Program shall be managed by the Director of the Division of Medical
11       Assistance (Medicaid Director), who shall be recommended by the Secretary of Health and
12       Human Services and appointed by the Governor, subject to confirmation by the General
13       Assembly by joint resolution. […]

This provision should raise many questions and concerns. The legislature does not have appointment authority over any other position that is so central to carrying out the policy agenda of the Governor. If, for example, the legislature is bent on limiting access to Medicaid while the Governor wants to streamline enrollment, then the conflict will likely shut down any ability to get a Medicaid Director in place.

And while there is a clear process to appoint a Director if the Governor does not forward a nomination, the budget does not spell out what happens if the legislature refuses every nominee from the Governor. What would most likely occur is that the Governor would have to wait until the legislature is out of session and then appoint a temporary Medicaid Director.

If all of this sounds familiar it’s because this is how the process works in Washington, DC, where politics clouds every decision and ties up the basic functions of government. Instead of fostering bi-partisanship and stability, Congress has caused major disruptions in the running of Medicare and Medicaid by refusing to approve presidential nominees.

The same is likely to happen in Raleigh.

The Governor, who is elected statewide, should be able to appoint his or her preferred Medicaid Director to carry out the policies that he or she was elected to enact. If this confirmation requirement survives negotiations between the House and the Senate then leadership elected in select pockets of the state will have veto power over how the Governor runs one of the most important agencies of the executive branch.

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The folks at Carolina Public Press in Asheville have more responses from the trenches today in a story about the North Carolina Senate’s proposal to privatize Medicaid and do away with the state’s award-winning Community Care NC program:

“Medicaid management nonprofit faces closure

Community Care of North Carolina, a nonprofit with 14 networks across the state — including Western North Carolina — would lose its contract with the state under the Senate’s plan.

The proposed elimination of the nonprofit network is part of the Senate’s plan to remove Medicaid management from the state Department of Health and Human Services and create a new agency to handle the program, as noted in its budget document.

Community Care of Western North Carolina, which has an office in Asheville, serves eight WNC counties: Buncombe, Henderson, Madison, McDowell, Mitchell, Polk, Transylvania and Yancey, according to its website. It serves 64,342 Medicaid enrollees, according to July 2013 figures, with an additional 12,000 enrolled in other programs. Read More

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ICYMI, be sure to check out this editorial in Raleigh’s News & Observer entitled “Gov. McCrory’s Medicaid plan should prevail.” As the editorial notes:

“McCrory’s plan, developed over months of consultations with North Carolina providers, would make quality care its first goal, but it would also produce savings through preventative care and more efficient delivery of medical services.

McCrory’s plan would replace the cost-inflating, fee-for-service approach now in use and instead pay providers for making people well and keeping them from getting sick.

The foundation for this approach is already in place through North Carolina’s nonprofit Community Care program. Now it needs to be refined and expanded.

The governor has done well to listen to doctors about improving Medicaid. Now let’s hope he can get the General Assembly to listen to him.”

Read the entire editorial by clicking here.

/www.newsobserver.com/2014/06/05/3914338/gov-mccrorys-medicaid-plan-should.html?sp=/99/108/#storylink=c the entire piece by clicking here.
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MedicaidThe following essay comes from Dr. William Dennis, President of the North Carolina Academy of Family Physicians:

Senate spending plan: The wrong treatment plan for an incorrect diagnosis

As a family physician, I am trained to process and understand the symptoms my patients present for the sole purpose of making a correct diagnosis. Once the correct diagnosis is made, it becomes my imperative to develop a treatment plan that addresses the underlying health concerns, not just remedy a patient’s symptoms. Only then can I deploy the necessary healthcare resources to ensure the best possible outcomes for my patients. Successful Medicaid reform is no different.

Over the past 16 months the state’s healthcare community, working closely with the General Assembly, the Governor, the Medicaid Reform Advisory Group and representative patient advocates, have made tremendous progress in diagnosing the ills of our Medicaid system and proposing priorities for reform and continued investment.

Some of these include:

• Improved Budget Forecasting – The actual spending per Medicaid recipient has been decreasing, with overall claims spending growing at a rate lower than the growth in the number of Medicaid recipients. The most significant cause for continued cost overruns is linked to budgeting inaccuracies, not care delivery.

• Continued Investment in “Medical Homes” – Community Care of North Carolina’s (CCNC) nationally recognized platform of “medical homes” provides services and care that is better coordinated to meet the needs of each patient. They leverage technology and care management to prevent chronic disease where possible, and maintain patient course of treatment where necessary, all of which reduces costly occurrences of hospital re-admissions and unnecessary emergency room visits.

• Adoption of New Payment Mechanisms – Movement away from the current fee-for-service model that ties compensation to volume of patients seen, towards physician-led accountable care organizations that reward improved health outcomes by focusing on prevention and chronic disease management.

But last week’s Senate Spending Plan is a complete departure from this process and the progress it has yielded. Senate leadership has developed an arbitrary treatment plan for an incorrect diagnosis that will ultimately damage the healthcare system that serves all North Carolinians. Read More

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Adam O'Neal

Mayor Adam O’Neal – photo credit Twitter.com

“You can’t close hospitals and let people die to prove a point.” So spoke the conservative Republican mayor of Belhaven, North Carolina, Adam O’Neal, this morning at a press conference at the state Legislative Building in Raleigh.

O’Neal’s appearance (and his linking of hands with Rev. William Barber of the North Carolina NAACP) was the highlight of a powerful event at which advocates called on Gov. McCrory and legislative leaders to reverse course and admit that their ideologically-driven decision to refuse to expand the state’s Medicaid program under the terms of the Affordable Care Act is threatening the physical health of hundreds of thousands of North Carolinians and the financial health of dozens of hospitals — especially ones located in poorer, rural communities like Mayor O’Neal’s.

O’Neal’s speech was an especially moving and courageous act by a man who claimed to disagree with Rev. Barber on most issues and who obviously placed any political ambitions he might harbor at risk by so publicly breaking with the leaders of his own party. But it was also obviously heartfelt and genuine — a fact that made it all the more powerful. Read More