By Rose Hoban

All dressed up and ready to … wait?

That was the prevailing sentiment in Pinehurst this week at the annual Center for Integrative Health conference designed to help Medicaid providers, contractors and patients share best practices. Even though the Pinehurst resort was decked out in holiday finery, many of the folks who attended were feeling profoundly unsettled as they tried to grasp what was happening with the Medicaid transformation that was supposed to roll out last month, then in February and now, who knows?

“We’re just kind of like sitting on the edge of our seats waiting to be told what to do next,” said Jenny Gadd, chief compliance officer with Alberta Professional Services, a mental health agency that works with people with intellectual and developmental disabilities. “It’s been really disheartening and unclear where to go from here.”

For four years, the Department of Health and Human Services, physical and mental health service providers, the managed care organizations that will run the new system, and North Carolina’s entire health care system has been gearing up for the change. Under transformation, the Medicaid program will go from one that pays for each individual visit, shot and test, to one that pays providers a lump sum in exchange for better health outcomes for beneficiaries.

But the ongoing tug of war between the General Assembly and Gov. Roy Cooper over the budget and over expanding the Medicaid program to include an additional hundreds of thousands of low-income beneficiaries has brought that transformation to a screeching halt.

In November, the department announced it was suspending the work to facilitate the changeover because they didn’t have the budget dollars.

And that has people wondering what to do.

Planning, then chaos

At a session on Tuesday, leadership from the DHHS worked to provide reassurance that the delay is just that, a delay, and that the changeover would happen eventually. But Medicaid head Dave Richard was unwilling to put a date on it.

“We do not want to set a date until we have absolute certainty about the budget,” he told NC Health News. “We feel that the two times previous to this that we’ve had the go-live date, the November launch and February one, that people were geared up to do that work, they were prepared to do that work, and then we changed it and that just creates lots of chaos and conflict with folks.”

That chaos was reflected in comments from care providers, who had put in a lot of work to make the changeover, and who are also stymied in their efforts.

Gadd said her agency was gearing up to hire a new compliance officer to handle the new paperwork that managed care will bring.

Woman stands gesturing with her hands in front of a sign reading: Value: where public dollars purchase real and positive results in people's lives.
Laurie Coker, who runs a peer-lead community center for people with behavioral health issues talks to a session during the Center for Integrative Health conference in Pinehurst on Wednesday. She said she’d heard from people dropping into the center were looking for answers about the suspension of Medicaid’s transformation. Photo credit: Rose Hoban

“We have interviews scheduled and stuff, like we were just about to make that move,” she said. “And then this came down, so now I’m like, I don’t know if [we] should proceed or wait.”

DHHS is experiencing some of that chaos as well. Richard said the agency had not laid employees off, but multiple contractors will have to go. He also said it was likely the managed care companies will lay off contractors and technical experts they had hired to create information management software, enrollment systems, data analytics and lay the groundwork for change.

“We just can’t continue to have those folks on during the during the timeframe, when we don’t know when we’ll go live,” he said. “And we don’t have the access to the dollars.”

The department is keeping the enrollment broker on contract until Dec. 13 in order to staff the phone calls coming in from people around the state trying to figure out what is going on. About 150,000 Medicaid beneficiaries had chosen which managed care company they wanted to get their care from. The rest of the people who were slated to change over, more than a million people, were supposed to be assigned to managed care companies early next year. That’s also on hold.

Consumers confused

There’s fear and confusion among beneficiaries, said Nancy Baker, an Asheville resident who has a son with an intellectual and developmental disability who lives in a group home. Baker does a lot of advocacy around Medicaid, which is a lifeline for her son and she’s on the board of the mental health agency in the western part of the state.

Nancy Baker, a board member with Vaya health spoke about Medicaid transformation
Nancy Baker, a board member with Vaya Health in Asheville expressed frustration at the delay of Medicaid transformation. “My main concern is our legislators have lost sight of the human aspect of this,” she said. Photo credit: Rose Hoban.

“They don’t know where to turn,” she said. “They get a letter, we try to educate and tell them you know, ‘you’re going to be under an insurance plan.’

“Then they get this letter that goes ‘Oh wait a minute, we’re on hold again.’ And you know, they have no earthly idea what that means,” she said.

Rebecca Judge, a board member from Eastpointe, the mental health provider in the Southeast, said many of their clients were “frustrated and confused.” 

“When it was suspended, a lot of people didn’t understand why,” she said.  

“I don’t care how much you put out in the news. I don’t care how many phone calls you make. I don’t care how many letters you send, you’re never going to reach everybody and they’re never going to understand,” Baker said.

Michelle Laws, assistant director at the Division of Mental Health, Developmental Disabilities and Substance Abuse Services, said her agency was trying multiple methods to reach beneficiaries, including listening sessions, webinars, videos and mailings.

“We’re trying to reassure people that the suspension will not disrupt services,” said Laws, whose focus is on engaging consumers around the state.

“I had one person come up to me today and show me a postcard she had received in the mail several weeks ago telling her daughter to do the open enrollment process,” said Kody Kinsley, deputy secretary for behavioral health and intellectual and developmental disabilities for DHHS. “She wanted to know what she needed to do.”

A man talks to a woman sitting in a wheelchair, they're talking about Medicaid transformation
Patient advocate Jean Andersen speaks to DHHS Deputy Sec. Kody Kinsley after a session at the conference to discuss changes to Medicaid taking place this week in Pinehurst. Photo credit: Rose Hoban

He told her that for now, the answer was, “Nothing.”

Slow restart

Richard expressed hope that when the General Assembly returns to Raleigh in January for an abbreviated session, DHHS’ budget issues will finally get addressed.

The department has not yet calculated the cost of the suspension, but Richard put it in the millions, perhaps in the tens of millions of dollars. Some of that cost will be in restarting contracts and getting things back up to speed when the process does go forward. Some of the cost is that open enrollment will have to be re-done because beneficiaries who selected plans before may change their minds.

“The longer it takes us to restart, the harder it’s going to be, both to get these people back and to then recreate that,” Kinsley said. “The longer we delay, it’s kind of an exponential or at least multiplicative impact to try to get the team back together.”

Kinsley and Richard worried that when the process does restart, it might be hard to motivate people.

“We were seven weeks away from going live,” Richard added. “It’s a disappointment for all of our teams that we’re not making that but recognizing that we obviously have to have the right budget for us to be able to move forward.”

Liora Engel-Smith contributed to this story.

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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...