Sept. 17--RALEIGH -- Legislators have agreed to privatize North Carolina's $15 billion Medicaid program, a change that doctors and hospitals have been fighting for months, but which some Republican legislators have championed as a remedy for unpredictable spending.
Under the plan, three insurers would be given contracts to run statewide Medicaid managed care organizations, and 10 "provider-led entities," or groups of doctors and hospitals, would enroll patients in regional networks.
Rather than pay for each hospital visit or medical procedure as it does now, the program would provide the companies with a per-patient payment. The government would not be liable for cost overruns.
Sen. Ralph Hise, a Spruce Pine Republican and a lead negotiator on the bill, said the changes will allow the state to control Medicaid growth and will provide an avenue for patients to get better care.
Medicaid is the government health insurance program for the poor, elderly and disabled. The federal government and the state share the costs, with the federal government picking up about two-thirds of the expenses.
The state will have to get approval from the federal government for these sweeping changes to the insurance program. About 1.8 million people in the state -- roughly 18 percent of the population -- use Medicaid.
Votes on the bill are expected next week.
Administrative changes will come with the changes to patient care and payments. The state will have a new division within the state Department of Health and Human Services -- called the Division of Health Benefits -- administering the Medicaid program. Employees within the new division will be exempt from the State Personnel Act, meaning they will work "at will" and without the protections of state personnel law.
Lynn Bonner: 919-829-4821, @Lynn_Bonner
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