RALEIGH — Medicaid transformation could be a casualty of the budget stalemate.
Gov. Roy Cooper, a Democrat, plans to put Medicaid transformation on hold indefinitely, Sen. Joyce Krawiec, R-Forsyth, says.
Medicaid funding was stuck in the budget stalemate for months. As Cooper and the legislature wrestled over Medicaid expansion, Medicaid transformation languished. Now, it could be stuck in purgatory.
The legislature adjourned last week, and won’t return until January. Krawiec says Cooper has planned a press conference on Wednesday, Nov. 20, to announce the delay.
But open enrollment has already begun, and state legislation requires the N.C. Department of Health and Human Services to begin rollout no later than April 2020. The legislature seems prepared to fight indefinite delays. Krawiec is arguing department Secretary Mandy Cohen lacks the authority to place the program on hold.
Medicaid managed care is the biggest change to hit the state since the inception of Medicaid. It would privatize the state’s Medicaid program by paying five managed care companies $30 billion over five years to cover 1.6 million low-income North Carolinians.
The transformation has been years in the making, ever since the Republican-led legislature passed managed care legislation in 2015.
The stalemate first delayed the program’s original November rollout, pushing transformation to February. As negotiations dragged on, even the February rollout seemed unlikely.
Cohen warned DHHS would be forced to delay rollout again if a budget didn’t materialize by mid-November, but the deadline passed without a budget.
The managed care companies risk hemorrhaging money. Cohen warned more delays would cost insurers dearly, as they had already hired staff and made investments in the transition.
The legislature passed the funding twice, once in the state budget and again in a mini-budget. Cooper vetoed both bills, and now the legislature is blaming the governor for the delays.
“This is another crisis of Gov. Cooper’s own making,” Krawiec said in a news release. “His veto will force insurers to lay off thousands of people they’ve already hired as part of the years-long plan to transform Medicaid.”
The managed care companies pleaded for a budget last week.
“Transforming North Carolina’s Medicaid program will improve health outcomes and provide whole-person care while lowering costs for taxpayers,” said N.C. Association of Health Plans in a statement. “But to keep this process moving forward and to not lose any ground, it’s critical that the state fully fund Medicaid transformation as soon as possible.”
The legislative leadership hoped to use managed care to control the cost of the program and improve health outcomes.
In late October, hospital lobbyists seemed to support further delays. Hospitals and providers have voiced concerns the program isn’t ready for transformation.
In late October, fewer than half of providers who saw a Medicaid patient in the last year had signed contracts. And only three hospital systems and 12 regional hospitals had signed on.
Medicaid transformation was supposed to unfurl in stages, but the budget stalemate forced the department to abandon staggered enrollment. Instead, the department planned to put all 1.6 million enrollees in Medicaid transformation Feb. 1. Now the future of the program remains uncertain.
Cooper did not respond to multiple requests for comment.
