The plan has been in the works since reform legislation was approved in September by the N.C. General Assembly.
The N.C. Department of Health and Human Services has helped coordinate and create the draft for the new program, which features a patient-centered approach.
Matthew Harker, policy director at the Duke-Margolis Center for health policy, said that Medicaid provides access to health services for those below the poverty line or those without sufficient healthcare coverage from employers.
“That’s 20 percent of the state that is currently covered under this access to care that otherwise they would not have,” he said.
North Carolina previously had a “fee-for-service” model, where the state set rates for services and where the provider billed accordingly, said Paul Mahoney, a spokesperson for Community Care North Carolina, in an email.
“The primary challenge was getting enough providers to accept low Medicaid rates to deliver services to a growing Medicaid population,” Mahoney said. “Cut rates too much, and physicians leave Medicaid in droves, and Medicaid recipients end up in emergency departments, costing even more.”
He said that Community Care North Carolina networks currently receive payments per patient, per month based on the health conditions of the patient — a strategy more individualized to the patient and to the doctors.
Harker said that the state’s desire to reform the Medicaid program stems from political contention over the Affordable Care Act from 2010.
“What’s happening is McCrory is saying, ‘Oh we have these budget shortfalls,’ — it’s because after the ACA they refused to take the Medicaid expansion,” Harker said.
Accepting the Affordable Care Act would have given states Medicaid expansion funds to help support the program, he said.
“Every state that did not take Medicaid expansion has had a significant drop in their overall budgetary lines to run the Medicaid programs as they existed pre-ACA,” he said.
The draft leaves questions about its effectiveness, Harker said.
“I’m on the side of I think it’s going to do more damage and dismantle what I think the state has done — (which is) a pretty good job compared to other southern states specifically,” he said.
Harker said although Medicaid privatization is on the horizon, he is unsure of what this privatization would look like.
“To me, the biggest issue is all of the South has not taken any of the expansion funds, and I’m not sure how that is mitigated with privatized businesses coming in,” he said.