A portion of North Carolina's Medicaid population won't shift to managed care coverage this fall due to the extended state budget stalemate, the Department of Health and Human Services announced on Tuesday.
Managed care was supposed to go online for Medicaid enrollees in 27 northern counties on Nov. 1, with the rest of the state phased in on Feb. 1. But without funds to cover the transition and final changes needed to set rates for health care entities providing coverage, the first batch of counties can't move forward that quickly, DHHS Secretary Mandy Cohen said.
"Without a new budget ... we do not have the ability to go live with managed care," Cohen said. Managed care services are now scheduled to begin in all 100 counties on Feb. 1. Cohen suggested the updated rollout schedule could be revisited again if a budget isn't worked out by mid-November.
The updated managed-care language was contained in the budget bill, but Democratic Gov. Roy Cooper vetoed the bill in late June, in large part because it lacked Medicaid enrollment for hundreds of thousands of additional adults through the 2010 federal health care law.
Republican lawmakers last week sent him a stand-alone measure containing similar Medicaid managed-care provisions, but he vetoed that too, citing health care as "an area where North Carolina needs us to do more, and to do it comprehensively."
Starting with a 2015 state law, Medicaid is moving from a traditional fee-for-service model to one in which four private insurers and a physicians' partnership awarded contracts by the state will receive fixed monthly payments for every patient seen. About 1.6 million of the 2.1 million Medicaid enrollees in North Carolina will participate for now. Health officials say the changes should lead to improved health outcomes and more fiscal stability for Medicaid, which spends about $4 billion in state tax dollars annually.
Cohen, a Cooper appointee, said even if the governor had signed last week's bill, there wouldn't have been enough time to get everything in place for a Nov. 1 rollout. And the general budget uncertainty this summer already had slowed down her agency's work to finalize contracts with health care providers, she said.
When Cooper vetoed the Medicaid bill last week, Republican legislators said the governor was letting his demand for expansion get in the way of carrying out needed Medicaid reforms.
Cohen acknowledged that bringing all 100 counties online at the same times increases the risk for operational problems that the original phase-in could have possibly avoided.
Medicaid recipients in the 27 counties — stretching from Boone to Rocky Mount and including the Triangle and Triad — will be contacted about the delay. Open enrollment — when enrollees can choose which health plan they'll use — in those counties will now continue until Dec. 13, when enrollment in the other counties also will end. Enrollment in the 73 counties begins Oct. 14.