Possible Medicaid changes debated
By Phyllis Moore
Published in News on April 10, 2016 1:45 AM
The state director of Medicaid made a stop in Wayne County on Thursday night, addressing the Wayne County Medical Society about the current 1115 Waiver Proposal to revamp the program.
Dave Richard, director of the N.C. Division of Medical Assistance, or Medicaid, discussed the current effort, which converts the "fee-for-service" Medicaid program into a capitated program operated by pre-paid health plans (PHPs).
"The event is right in the middle of conducting 12 open hearings across the state to give citizens the opportunity to comment on the proposed Medicaid reform plan (waiver proposal)," said Dr. Dave Tayloe of Goldsboro Pediatrics and the local medical society, who invited Richard to speak at Walnut Creek Country Club.
While the local gathering was not considered one of the 12 public hearings, Dr. Tayloe said he had attended the first hearing in Raleigh last month and plans to attend others.
"Comments are due to the Department of Health and Human Services by April 18," he added, noting that he intends submit his own comments.
"Legislators decided to revamp Medicaid. We have got a model program but because of some cost overrides and some differences of opinion on how to solve the problem in Raleigh they passed this bill last year that would look at applying to the federal government."
The waiver asks for the federal government to contract out the Medicaid program to multiple payers. It also calls for looking at six districts in the state and up to two statewide payers in every district.
"For us (Goldsboro Pediatrics), we're in seven counties. We're in three districts," Dr. Tayloe said. "So we could have 15 payers to deal with for the Medicaid patients."
The proposal is not set in stone, he added, as the discussion continues around the state and there is more tweaking to be done before it is sent to the federal government by June 1.
"They'll take comments from people like you and me, make a decision about whether they're going to approve the waiver or not," he said. "We're hoping that we can get this down to a more workable solution.
"We don't think there's anything wrong with the current program."
The state, he pointed out, has provided access and high quality care in a cost effective manner.
Davin Madden, Wayne County health director, also had an interest in the topic, as the Health Department is a "safety net" for many patients.
"Over 30 percent of our clients are Medicaid," he said, pointing out that the bulk of prenatal care in the county is through Medicaid.
Richard agreed that there has been reliance on the state system for a long time. It has for the most part, he agreed, been a "model program."
"What we're pushing is, let's try to push beyond what we're able to do today," he said. "How do we actually get to that individual and to that patient? How do we take personal responsibility for managing their health if we give them to the tools, if we want other organizations involved other than just the health community.
"It would be a failure if you choose not to be a Medicaid provider on this new plan. We have to set the standard at a level that you want to be."
Richard said there would be adjustments to the waiver once the medical community and public weighs in. Until then, it is still very vague at this point, he said.
"When we started talking about the contract, that contract will be very transparent because without that you're not going to be assured that we're doing the best we can," he said. "We're going to have to do what we say we're going to do.
"This transformation has to be something that's better than what we're doing today or it's not worth making the change. No one wants to see that happen."
Medicaid agencies across the country are struggling, Richard said. The $94 billion organization serves 1.9 million beneficiaries.
Anyone who says they understand everything about Medicaid is lying, he suggested, since the program is both complex and convoluted and "doesn't make a lot of sense."
"We have to correct it because it's so complex," he said.
Pediatrician Dr. Katherine McDonald took issue with the revamp, saying she is concerned that it will not focus on the community feel that is at the heart of the current program.
"It's like firing Coach K at Duke," she said of the winning basketball coach. "Why take that out? It serves our families. It seems dumb."
Pediatrician Dr. Joe Ponzi also had his doubts, calling the literature "pie in the sky information" that sounded like it had been written "by someone on LSD," evoking laughter from the audience. He later attributed the reference to having grown up in the '60s.
"This is ridiculous," he said. "It's about money. Seventy percent of those enrolled in Medicaid are children."
Madden said his concerns were with keeping quality employees who want to do the job in place, especially serving such a "vulnerable population."
"Trying to do it with an unknown (managed care plan) really scares me as a health director," he said.
"There are a lot of issues, a lot of places that we all have to dig in deep," Richard said. "I'm confident that if it looks as though we're going to miss a deadline or cause more disruption than it should be, we are going to be able to talk to the General Assembly.
"What I believe from this administration and members of the General Assembly, this is about let's get it right."