Gov. Pat McCrory announced plans a create the Partnership for a Healthy North Carolina, a statewide Medicaid managed care plan in April, 2013.
Gov. Pat McCrory announced plans a create the Partnership for a Healthy North Carolina, a statewide Medicaid managed care plan in April, 2013. Photo credit: Rose Hoban

By Rose Hoban

Leaders of the General Assembly announced Friday they’re joining with Gov. Pat McCrory to ask the federal government for a waiver to change the state’s Medicaid program.

Speaker of the House Thom Tillis and Senate President Pro Tempore Phil Berger said they’re getting behind McCrory’s call to the federal Centers for Medicare and Medicaid Services to grant permission to restructure the program that serves about 1.8 million of the state’s low-income children and their parents, pregnant women, people with disabilities and the elderly.

We cannot continue to have frequent unplanned Medicaid shortfalls that wreak havoc on the budgeting process,” Tillis wrote in a prepared statement released Friday morning. “Medicaid must stop being a budgetary time bomb.”

The House passed a bill Thursday afternoon to cover a $401 million shortfall in the program for the fiscal year that ends in June.

“The budget we introduce next week must include over $1 billion in additional funding for out-of-control Medicaid costs,” Berger wrote in the same statement.

In announcing his desire to reform Medicaid, McCrory announced in April he had sent a letter to U.S. Department of Health and Human Services Sec. Kathleen Sebelius asking for the waiver. Kim Gennardo, the governor’s spokeswoman, said the governor has not heard back from Sebelius.

Partnership for a Healthy N.C.

According to CMS rules, the governor can negotiate a waiver, but nothing will happen until a detailed plan with a request for a state plan amendment gets submitted to the federal government.

In public meetings around the state, state Department of Health and Human Services Sec. Aldona Wos has been describing the plan to groups of doctors, health care providers and members of the public.

Wos and McCrory will be asking for a so-called 1115 waiver, described by CMS as being designed to use “innovative service delivery systems that improve care, increase efficiency, and reduce costs.”

Wos has said she and the governor would like the waiver to go into effect in July 2015.

In an exchange with Gennardo about the level of detail required for the proposed waiver, this reporter suggested the current plan being outlined in public meetings by Wos has been long on generalities but lacked detail.

“That’s your opinion,” she responded.

But attendees to Secretary Wos’ public hearings have been expressing their confusion about the proposal.

“The model isn’t clear to me, that’s part of the problem,” said Carmesia Straite, a manager from Triad Adult and Pediatric Medicine, a community health clinic in Greensboro. “I think it will be us contracting with the managed care organization… I think. And then our patients will have to be part of that, but how that will work, I don’t know. It’s really not clear.”

Waivers take time

Gennardo also suggested “asking the feds what level of detail they’ll need to see.”

According to a CMS spokeswoman, because Medicaid is jointly run by the state and federal governments, the two entities have to agree on the details of a state plan, a process that can take months.

Federal documents show obtaining a waiver takes significant negotiation with officials at CMS over a period of months. A state department has to provide a detailed plan including rates paid to providers, the level of benefits for recipients, how people get paid, how the program is administered and more.

Every state also is required to provide an opportunity for public comment and for public hearings on the plan.

In 2011, the General Assembly approved the creation of another kind of waiver to move the mental health system over to a regional managed care model. That bill was passed in June 2011, the last of the mental health managed care organizations began operations in the past few months and the full waiver will officially be in place on July 1 of this year.

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Rose Hoban is the founder and editor of NC Health News, as well as being the state government reporter. Hoban has been a registered nurse since 1992, but transitioned to journalism after earning degrees...