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Health care executives discussed what Medicaid reform could mean for providers of behavioral health services, and the role Medicaid expansion could play in getting the reform measure approved.
By Taylor Sisk
A panel of health care executives was convened on Monday at the Renaissance Asheville Hotel to discuss the Medicaid reform bill just signed by Gov. Pat McCrory and what it could mean for providers of mental health, substance disorder and intellectual and developmental disability services.
Titled “Medicaid Reform: What Will it Mean to You?” the discussion was hosted by Smoky Mountain, a mental health LME/MCO in Western North Carolina, and included the agency’s CEO, Brian Ingraham.
House bill 372 will reshape the state’s Medicaid program, which provides health care coverage for some 1.8 million North Carolinians who live in poverty, have disabilities or are elderly.
The provisions of the bill must now be approved by the federal Centers for Medicare and Medicaid Services, a process that could take more than a year. If then given the go-ahead, an extended implementation slog will commence.
“It’s going to be rough,” Karen McLeod, president and CEO of Benchmarks, an umbrella organization for children’s advocacy groups, said of the transition. “That’s just the nature of the beast.”
But McLeod and her fellow panelists offered advice to the service providers assembled on how to best weather the storm and prepare for the future.
Several panelists also expressed hope that the reform would help pave the way for Medicaid expansion in North Carolina, which the legislature’s Republican leadership has thus far opposed.
Joining Ingraham and McLeod on the panel were Dave Richard, deputy secretary of medical assistance at the state Department of Health and Human Services; Jeff Heck, president and CEO of the Mountain Area Health Education Center; and Marc Malloy, senior vice president of health plan solutions at Mission Health.
Lanier Cansler – former secretary of DHHS, a former member of the state House of Representative and now an Asheville-based consultant – served as moderator.
“We have an opportunity to make a significant change in the future of health care,” Richard told the audience. “And if we get it right – if we get it right together – then we’ll have a chance to look back and say, ‘This has made a difference.’”
Legislators’ impetus for reform, Richard said, is to create a system that can be predictably budgeted and is “outcome-based.”
“As providers, the first thing I’d be paying attention to is what are your outcomes? What are the things you’re doing that set you apart?” Richard said.
As behavioral health services providers, he said, they must also consider how they can best collaborate with primary care providers. “It can’t be a siloed system; it can’t continue to be that way. There’s a lot of talk about whole-person care,” Richard said, and providers should be “looking for innovative approaches to that.”
“Innovation is something that has to happen at the local level,” he said. “What you can bring to the table in innovation is going to make a huge difference.”
Heck echoed Richard, stressing that “primary care and behavioral health have to work together. Not just from a distance, not by telephone, not by letter. I think we have to be in each other’s offices.”
Heck said he believed that any primary care office with more than four providers should have a behavioral health specialist onsite.
The case for expansion
In response to a question about the role Medicaid expansion could play in the Centers for Medicare and Medicaid Services handling of the reform proposal, Ingraham said there’s been some speculation that the legislature’s refusal to expand could be a deterrent to approval.
“That’s not an unreasonable thought for anyone to have,” he said.
McLeod said that when “you have a conversation and you develop relationships with Republican leadership, they will tell you, “Yeah, I really think [expansion] is a good idea, but the party is not on board with this.’”
But, she explained, the state’s proposal includes a provision that she believes “provides an opening for expansion.”
The bill calls for the creation of a Division of Health Benefits to replace DHHS’ Division of Medical Assistance, the part of the department that currently runs Medicaid.
Legislative leadership, McLeod said, insisted that Medicaid wasn’t properly managed, that it needed improved oversight.
“Now they can own something new,” she said. The new division will provide them with “something that they’ve created that they feel puts more controls and oversight in place.”
Expansion, McLeod added, won’t occur before next year’s elections. “But I’m really hopeful that this might open the door.”
Ingraham agreed: “I don’t know what barriers would be left.”
“It’ll be a great day when we get expansion,” he said.