A Rundown Of The House's Medicaid Reform Bill
Publisher's note: The author of this post is Katherine Restrepo, who is the Health and Human Services Policy Analyst for the John Locke Foundation.
The prescription for improving North Carolina's Medicaid program has been a repetitive talking point for the past two years. The initial game plan back in April 2013 was for the state to contract with at least three private managed care organizations (MCOs) to take on full risk for managing holistic medical needs for all Medicaid patients — carve outs not included.
The following year, the Department of Health and Human Services went back to the drawing board and began advocating on behalf of provider-led groups to accept the job under an Accountable Care Organization (ACO) framework. These ACOs would share any savings or losses with taxpayers if they were to exceed or come in under their defined budget. Incentive-based bonuses would also be allocated if providers met benchmark quality metrics reflective of patient satisfaction and health outcomes.
At present, the Senate seems steadfast on allowing both managed care companies and provider-led organizations to coordinate health services for medical assistance patients. Meanwhile, the House advocates for providers and hospital systems to play the role of both provider and insurance company.
Wednesday's House Health Committee meeting provided a more in-depth explanation of the chamber's modified HB 372. Some key components are as follows:
Overall, major stakeholders in the House of Medicine have made enormous strides within a year's time to agree on assuming full financial risk for their Medicaid patient pool. This is huge. However, to ensure Medicaid reform allows for healthy competition, it would be ideal to have both PLEs and MCOs compete to deliver tailored health care to Medicaid patients under the flexibility of an approved Centers for Medicare and Medicaid Services (CMS) 1115 waiver.