NC Lawmakers examine medicaid

With a battle brewing in the N.C. General Assembly over a potential rise in state Medicaid costs, legislators are considering a number of reforms to make the program more efficient.

During the last two years, a Blue Ribbon Commission on Medicaid Reform collected information about the program, proposing several new measures designed to increase its effectiveness.

In response to those suggestions, several bills have been filed in the N.C. House as state legislators attempt to rectify problems within the program.

Funding, experts say, is likely to be the greatest issue facing these proposals.

Across the state, county governments are being asked to put up more funds for Medicaid, said Adam Searing, spokesman for the North Carolina Health Access Coalition.

Urban counties have not suffered too terribly from the cost increase, he said, but some rural counties have been hit hard.

In some counties, “per capita Medicaid costs are more than per capita school costs,” Searing said. “We can’t expect counties to continue paying that much for health care.”

Jim Cook, social service director of Cabarrus County, claims that county governments pay up to 15 percent of total Medicaid costs in the state.

“It’s harder for counties to fund the entire array of programs necessary,” he said.

This year, Cabarrus County alone budgeted more than $5 million, Cook said, and more rural counties can barely afford such costs.

Rep. Julia Howard, R-Davie, said she hopes the bill she is co-sponsoring will help many of these counties. Her legislation provides for a case-management program to ensure greater efficiency, and she proposed Wednesday a bill to gradually phase out the required contributions from counties.

Howard said she is hoping to “gain a handle on Medicaid funding and expenditures.” She claims that two of the proposed bills already call for a $1 million increase in spending, which she called “very disappointing.”

But many of these bills might be necessary, said Gary Rozier, professor of health policy and administration at UNC’s School of Public Health.

He cited a proposal that would increase dental rates for adults, which he said would give a greater number of Medicaid recipients access to proper dental care by providing more funding for the program.

Rozier said there has been a back-and-forth battle between the state legislature and dental providers who participate in Medicaid. Dentists have complained that the program does not fully compensate the cost of many procedures for Medicaid recipients.

“This is a severe problem and a continuous struggle” he said.

Still, he said that for the program to be a success, there will be a need for yearly increases in dental funds.

“Medicaid dental fees have been pretty dismal,” Rozier said.

He said he hopes that rates will be increased in the future so more Medicaid recipients’ dental bills will be covered.

Tom Ricketts, professor of health policy and administration at UNC, said he anticipates many of these programs becoming self-sufficient as they mature.

While Ricketts views many programs as a particular burden to small counties, he said Medicaid, in general, is “an experiment at the state level, attempting to implement a form of managed care.”

While he doesn’t view county expenditures as a “drop in the bucket,” he said it is a small part of a larger program.

Contact the State & National Editor at stntdesk@unc.edu.