RALEIGH — The managed care implementation and open enrollment for NC Medicaid has been suspended because of a lack of funding.

The North Carolina Department of Health and Human Services announced Tuesday the suspension of the transformation of the state’s Medicaid program from fee-for-service to managed care and placed the blame squarely on the General Assembly, a claim Republican lawmakers reject.

A press release from the department reads in part, “The General Assembly adjourned last week without providing required new spending and program authority for the transition to managed care. Managed care will not go live on Feb. 1, 2020.”

“We have been working on this for many years,” said Dr. Mandy Cohen, state DHHS secretary.

In 2015, the General Assembly enacted legislation directing DHHS to transition Medicaid and NC Health Choice from fee-for-service to managed care. Under managed care, the state contracts with insurance companies, which are paid a predetermined rate per person to provide all services. The department was on track to go live on Feb. 1, but new funding and program authority was required from the General Assembly.

“My team has worked hard and we are disappointed,” Cohen said. “They work very hard for the betterment of the residents of North Carolina.”

The department delayed the transformation process in July after Gov. Cooper vetoed the state’s two-year budget, she said. But the department continued the process in hopes of a budget compromise.

The House overrode the veto, but the Senate has not, leaving the state without a budget that would include budgetary authority to proceed with the transformation.

Cohen said she repeatedly told legislative leaders she needed that authority, and the money that came with it, by mid-November.

Now it will be 10 to 12 weeks before state lawmakers will be back in Raleigh to take up budget issues, including giving DHHS the authority to continue the transformation, Cohen said.

In the meantime, nothing will change for Medicaid beneficiaries, according to the DHHS news release. They will get health services as they have been. Behavioral health services will continue to be provided by Local Management Entities/Managed Care Organizations. All health providers enrolled in Medicaid are still part of the program and will continue to bill the state through NCTracks.

One change Medicaid beneficiaries will see is at the program’s call center, Cohen said.

The Medicaid Managed Care Call Center, 833-870-5500, will stay open through Dec. 13 to answer questions but will no longer enroll beneficiaries in a health plan, according to the press release. Beneficiaries can continue to contact the Medicaid Contact Center, 888-245-0179. Notices will be sent to beneficiaries informing them to continue accessing health services as they do now, rather than through new health plans.

Enrollment for the new managed care system began in July in some parts of the state, Cohen said. Enrollment went statewide in October.

DHHS awarded five managed care contracts in February, Cohen said. The contracts collectively are worth $6 billion a year for at least three years, with an option for more years. But, the contracts allow the companies to do work to get ready for the transition to managed care, and the money is not to be paid out until the transformation was launched.

“They’ve done a lot of work to get ready,” Cohen said.

The department also has employed vendors, such as for technology services, to help make the transformation happen, Cohen said. Now their services will have to be scaled back.

What that means to the vendors’ employees is unclear at this point, she said. Some of the vendors have multiple company entities and other projects. Some of the employees could be transferred to other projects.

“We are worried that some talented people will be assigned to other projects and won’t be available when the Medicaid transformation starts up again,” Cohen said.

The announcement by DHHS launched a chorus of objections by Republican lawmakers.

Lauren Horsch, a spokesperson for Senate Leader Phil Berger, said in a statement, “The General Assembly already passed a clean Medicaid transformation bill with the funding Secretary Cohen said she needed to do her job. In fact, the bill removed cuts that were in the budget to accommodate Secretary Cohen’s requests during negotiations. Nevertheless, despite his own DHHS secretary saying she needed the more than $500 million the legislature tried to provide to her, Gov. (Roy) Cooper vetoed the funding. He is the only one to blame for DHHS having to shut down its Medicaid transformation efforts.”

House Speaker Tim Moore’s office issued a release that says Cooper twice vetoed hundreds of millions of dollars in Medicaid transformation funding, once in the state budget and again as a stand-alone appropriations measure.

“The state General Assembly has invested heavily in fixing massive cost overruns in Medicaid that diverted funds from other state government priorities like public education into the program until 2013,” Moore’s release reads in part.

Though Cooper insists Medicaid expansion should be part of the transformation process, Democratic State Auditor Beth Wood recently disagreed after conducting a performance review and blamed a “lack of accountability” in Medicaid administration for the program’s consistent financial troubles, according to Moore.

“You can’t just keep putting a bunch of people into a system that is already broken,” Wood said in October. “We’ve got to clean up what we already have.”

Berger
https://www.robesonian.com/wp-content/uploads/2019/11/web1_Berger-2.jpgBerger

Cohen
https://www.robesonian.com/wp-content/uploads/2019/11/web1_Mandy-Cohen.jpgCohen

T.C. Hunter

Managing editor

Reach T.C. Hunter via email at [email protected] or by calling 910-816-1974.