shows a red cross with the word Medicaid printed on it, in front of a pile of dollar bills. For Medicaid transformation

By Rose Hoban

In the coming two weeks, newly installed health and human services Secretary Mandy Cohen will hear feedback at public meetings around the state on North Carolina’s plan to overhaul the state’s Medicaid system.

Attend a Medicaid feedback meeting:


May 10, 3-5pm
Greenville Convention Center
303 Greenville Blvd. SW
Emerald Ballroom


May 12, 2-4pm
Asheville-Buncombe Technical College
340 Victoria Road
Ferguson Auditorium


May 16, 6-8pm
McKimmon Conference & Training Center
1101 Gorman St.

Last year, former Secretary Rick Brajer lead the effort to submit an application to the federal Centers for Medicare and Medicaid Services to make profound changes to Medicaid, the program that serves about 1.9 million low-income children, some of their parents, pregnant women, low-income seniors and people with disabilities.

The biggest changes may be noticeable to low-income patients, children and pregnant women who participate in the program, but the differences will be great to the doctors, nurses, hospitals and others who provide the care. Reimbursement for those providers’ work will change from payment based on performing individual services to a regimen where they will be paid a set amount per month for each patient and expected to provide everything that patient needs.

The changes were driven by the General Assembly, which voted in the sweeping changes in 2015. But a lot has changed since the original application was submitted to CMS in June 2016.

“You have a new administration, both in Raleigh and you have a new admin in Washington,” said Rep. Nelson Dollar (R-Cary), the House appropriations care who has been involved in health care policy making for close to a decade. “The waiver that has been put forward by the state certainly still needs additional work and additional specificity added to it.”

“Strong concern”

About 100 people attended the first of the public meetings, which took place last Monday evening in Greensboro, more than 30 of those people spoke.

In an email, Cohen said she saw the listening sessions as a continuation of the dozen listening sessions held last year by Brajer as his department was preparing the initial Medicaid overhaul application to federal regulators.

“There was strong concern that Medicaid is incredibly effective now,” said Elizabeth Hudgins, head of the North Carolina Pediatric Society, who was at the Greensboro forum last week. “It’s not that there’s not room for improvement but we were focusing on keeping the many things that do work in place.”

headshot of Cohen
Sec. Mandy Cohen. Photo courtesy: NC DHHS

Hudgins said many of the speakers last week spoke in support of Medicaid expansion to include more low-income families.

In the conference call, Cohen did not elaborate whether any changes to the plan might include expanding the program, as allowed for under the Affordable Care Act. If she did support expansion, Cohen would have to convince lawmakers in the state legislature who have resisted calls to expand. Some Republicans last month proposed a plan to expand coverage, but the bill has yet to receive a hearing in committee.

But for Hudgins, the message was more basic: Maintaining reasonable reimbursement and not overloading physicians with paperwork.

“Seventy percent of the people covered by Medicaid in North Carolina are children,” she said. “It’s not unusual for practices to have 40 to 60 percent of their patients insured by Medicaid. So making sure it’s a program that works well for pediatric providers is critical.”

Cohen said she’s interested in hearing more about people’s concerns, and in particular, is looking for feedback about seven areas of interest (see box).

Cohen says she wants to hear , in particular, about the following issues:

  • Integrating primary and behavioral health services, i.e. “How to care for the whole person to improve mental health?”
  • How can we support provider transformation or, in other words, “How can we help doctors and other providers transition to managed care?”
  • How can we provide care management and focus on population health, especially “How to manage care and improve overall health and not just treat injury or illness.”
  • She said DHHS is interested in addressing the social determinants of health, “That’s how to  consider the impacts of  income, housing, lifestyle and other social circumstances on health and other health care services.”
  • Focusing on improving quality of care.
  • Focusing on how to pay for value.
  • Increasing access to care and treatment.

Her goal for the sessions is to get feedback about what modifications might be needed for the waiver.

“I was delighted to hear from so many North Carolinians about the issues that matter to them,” Cohen said.

New ears

Cohen, who is new to North Carolina, has been traveling the state talking to many people about their concerns. She’s also been getting a feel for the state.

But even as Cohen’s learning curve is steep when it comes to western versus eastern barbecue and other North Carolina issues, Cohen is deeply experienced with the Medicaid program itself. Before coming to North Carolina, she was the Chief Operating Officer of CMS and has been involved in federal health care policymaking for at least a decade.

“Her expertise and her knowledge is really unparalleled,” said Ben Popkin, the DHHS assistant secretary for policy. “She knows better than anybody probably in the state or in the country operationally, about the how CMS operates and what variables they’re going to take into account as they consider our waiver.”

Popkin said one advantage to having Cohen help design North Carolina’s revised Medicaid program is that from her perch in Washington, she could see what worked well in states that had moved to managed care and what hasn’t worked.

“The real priority is to make sure that we hear from the public and hear what their priorities are and account for those as we’re putting together the waiver application,” he said.

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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...