Bill Would Untie Medicaid Benefits from Recipients’ Home Counties
Years ago, North Carolina counties paid part of a recipient’s Medicaid tab, but that practice was phased out in the past decade. Yet, recipients’ benefits are tied to their counties of origin, even if they now live across the state.
By Rose Hoban
Meg Moss and her husband adopted three boys six years ago; the youngest was just an infant, recovering from his mother’s addiction to cocaine. The older two boys had been abandoned in a trailer by their mother.
Because the Moss’ boys had developing physical and psychological problems, they were eligible for Medicaid.
“Both older boys had in-home intensive therapy,” Moss said. “That means there was a therapist at our house, two hours a day, five days a week for, like, nine months. Then they were able to move to three times a week, and now they’re weekly outpatients.
“So, oh, my gosh, progress has been made – exponential progress.”
But now Moss faces the termination of her foster children’s services because the boys were born in Cumberland County and the Mosses live in Lee County.
“Despite the efforts of our provider and multiple calls to the boys’ [managed care organization] by me, my boys’ services ended two Fridays ago,” an emotional Moss told the House Health and Human Services committee Tuesday morning. “We are desperate. We cannot start over again with new providers.”
Moss’ problem would be solved by a bill that was heard before the committee that would no longer tie a Medicaid recipient’s benefits to the county where they originally were approved for the Medicaid program.
That requirement is a holdover from when North Carolina counties paid a portion of a beneficiary’s Medicaid costs, but that county match was phased out by a bill passed in 2007. Nonetheless, counties of origin continue to control Medicaid purse strings.
Julia Adams, governmental affairs liaison for the Arc of North Carolina, told a story she knew about a person living in the mountains who was getting services from the mental health managed care organization (MCO) there.
“But that person’s Medicaid started in Pitt County, where that person was born. So, first, the provider had to negotiate a single-person contract with Eastern Carolina Behavioral Health,” Adams said. “Then they had to send two staff all the way to the eastern part of the state for the exact same training that they had just done, just to cover this one person.
Under the proposed bill, if a Medicaid recipient moved from one county to another, their eligibility would move with them.
The bill would also make it possible for people with developmental disabilities who receive intensive in-home supports to keep those supports if their family should move to another county, thereby avoiding the risk of a waiting list for services.
Rep. Verla Insko (D-Chapel Hill) pointed out that under the new mental health MCO model, some counties may provide more services than others. MCOs receive a set amount of money for each Medicaid beneficiary covered, and the MCO determines how to allocate those funds.
“One feature of the MCOs is that they manage Medicaid money, and they’re at risk, and they have authority to contract or not with a provider,” she said.
Insko is concerned that a person who moves from a county with richer services to one with lesser offerings might lose out.
“But if they move from that MCO to one that has a richer package … would they get the richer package?” Insko asked.
“If we have a citizen in one county and they move to another county, they should be able to get help,” said bill sponsor Marilyn Avila (R-Raleigh).
Forcing someone to drive back to the county in which they previously lived to receive needed services, she said, is wrong.
Moss said she hopes the legislature can act quickly to resolve this situation for her and others like her.
“The boys have 20 days of medications left, but 29 days of school,” she said, “and the school won’t let them come unmedicated.”
Moss said they were able to get medical records transferred to a local family doctor.
The boys are physically healthy, she said, and see their family physician for checkups and immunizations. And if necessary, she and her husband could get medications.
“But the family doctor doesn’t know them, doesn’t know the situation, doesn’t know the cocktail of medications that they’re on, doesn’t know the history of what has happened,” she said.
The bill passed the committee unanimously and now moves to the floor of the House, where it’s due to be heard on Wednesday.