By Rose Hoban
After years of computer glitches, poor data and budgets running in the red, North Carolina’s Medicaid program appears to be well in the black for this year, and computer systems seem to be providing timely data for officials to make projections and decisions.
Just in time for everything to change.
Officials from the Department of Health and Human Services updated lawmakers Tuesday on the state of Medicaid, the program that provides health care for about 1.8 million low-income children and their parents, pregnant women and people with disabilities.
They also gave lawmakers an update on their progress in remaking the program as mandated in House Bill 372, the Medicaid reform bill passed through the legislature last fall.
It was the first time DHHS Sec. Rick Brajer and his team appeared before the newly formed Joint Legislative Oversight Committee on Medicaid and N.C. Health Choice, and they had good news to share. According to the Medicaid chief financial officer, Trey Sutten, the program is at least $139 million (8.5 percent) under budget and spending less money compared to the same time last fiscal year.
Sutten said data coming out of the previously troubled NCTracks computer system shows that enrollment growth is slowing, people who are enrolled in the program are going to the doctor less frequently and when they do go visits are costing less.
“That’s the key takeaway here; our claims have been less than what we anticipated,” Sutten said.
Medicaid head Dave Richard also told lawmakers that increasing employment, combined with the phasing out of auto-renewal for many Medicaid beneficiaries could be a big reason enrollment growth is slowing. Richard did warn lawmakers, however, that DHHS officials could not be completely sure why the growth in new Medicaid beneficiaries has slowed.
“The good news is that we are below our projections; the caution is that we can’t explain all of that,” Richard said. “We’re digging deeper into that.”
Aggressive timeline
One of Brajer’s main tasks was reassuring lawmakers that his department would be able to meet short timelines stipulated in HB 372.
The bill calls for a newly created Division of Health Benefits to present a detailed outline of the reformed Medicaid system to the General Assembly by March 1 and complete a complicated application for federal approval by June.
Thus far, the Division of Health Benefits has only two employees: a human resources person and the director of operations, Dee Jones, who told lawmakers that there’s “significant activity taking place.”
Jones also told lawmakers that she was on track to hire another five employees by the end of this month and 20 more by the end of June.
In the meantime, she has brought in some familiar faces as consultants, including Bob Atlas, who originally came to DHHS in 2013 to consult on Medicaid reform.
At the time, then-DHHS Sec. Aldona Wos was criticized for giving Atlas an open-ended contract that paid him $250 per hour.
Sen. Tommy Tucker (R-Waxhaw) pointedly asked about Atlas’ current contract terms.
“He was at a rate of $250 an hour. What is being paid now under this contract? Will he live and work here five days a week or is he here purely as a consultant? And do we pay his expenses when he comes from his primary residence here to work?” Tucker asked.
Jones acknowledged that Atlas is still being paid at the same rate, but moved to reassure legislators that his contract had limitations.
“He’s getting $250 an hour. We have capped his time at $10,000 a month, or 40 hours,” said Jones, who assured Tucker that Atlas has thus far made only one visit.
“Most of this is because of the aggressive timelines,” Jones said. She noted that following the usual six-month process of requesting and reviewing bids was not feasible with the tight deadlines she’s facing. “We really needed the background that Bob provided and his experience in managed care and his experience broadly across the country in this space.”
Jones also said she’s asked for help from Mercer, a government contracting firm that’s done a lot of business in Raleigh.
“We’ve got to have a tight contract,” she said. “We’ve got some folks with [Centers for Medicare and Medicaid Services] experience, Medicaid agency experience on the team, and we have a list of deliverables, and there are penalties for not meeting the deliverables.”
Lessons learned
Dave Richard said that the long debate over the future shape of the program gave DHHS time to hire the kind of staff it needs to make the transformation.
“What people have missed is that over the course of the past two or three years, even though we had some turnover at [the Division of Medical Assistance], the leadership level, the talent pool was getting better,” Richard said. He asserted that the opportunity to change the program drew people to the department.
Richard also said DHHS leadership has learned a lot from the experience of creating managed care organizations for the mental health system.
Nonetheless, he acknowledged that it will be a “heavy lift” to get everything done within the time frame created by legislators.
When asked why someone would take on the daunting task of getting everything done in only a few months, Jones chuckled.
“This is all about improving the health outcomes for the most vulnerable population in North Carolina,” she said. “That’s a worthy task.”
Republish our articles for free, online or in print, under a Creative Commons license.
Mr. Atlas is being paid $250/hr while home health aides are among the lowest paid workers in the state. It is time for Medicaid to increase the PCS and CAP reimbursement rates so these workers can get a well deserved raise.