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North Carolina's Medicaid Reform Demonstration

Jun 21st 2016 9:22 am Response: #208989 Please make sure that federally qualified health centers continue to receive adequate reimbursement and that there is no hospital led efforts to minimize those reimbursements throughout the process. As hospitals continue to purchase primary care practices, they are under more pressure to corner those Medicaid dollars, leaving a poor payer mix for FQHC's.
Jun 22nd 2016 1:11 pm Response: #208997 The Medicaid reform proposal ignores some highly pertinent facts and is not in the best interest of our state. The format suggested will be cumbersome to formulate and will add layers of bureaucratic complexity to the Medicaid system in North Carolina.
This terribly divisive proposal ignores the fact that the NC Medicaid system is nationally recognized as doing well. It has over 90% of primary care and many specialists with support by nonprofit Community Care of NC which is a consortium of 14 nonprofit entities covering all 100 counties. It works with every hospital in NC, with thousands of private practicing physicians, with every county health department, with all 34 federally qualified health centers, and with all 27 rural health centers. CCNC is a model which numerous other states have tried to emulate.
While enrollment growth has generated an increase in total costs, the per capita cost of healthcare for Medicaid patients in NC has gone down since 2010. There was a 4% decrease in 2011, and by 2015 a greater than 8% reduction as compared with 2010. No Medicaid program in any other state has had such experience. In fact, no commercial insurance company nor any MCO can show such results. What is the logic of disrupting such a successful homegrown system with for-profit MCOs that will cost more and generate aggravations for the provider community?
Notable is that these cost savings under the current system have accrued through improved clinical outcomes for patients, resulting in less emergency department visits and less hospitalizations.
In recent 12 public hearings across the state over 100 physicians to speak expressed disapproval of the reform plan and spoke in support of CCNC. They also voiced serious concerns for having to deal with multiple entities within the Medicaid system to gain reimbursement for services delivered.
At these hearings were repeated pleas for NC to shrink the uninsured population by accepting the federal money that has been allocated to expand Medicaid in our state. To do so would help the economy in every county across NC, especially in the less affluent regions. It would generate jobs and be a huge boost to hospitals and safety net clinics.
NC has a model Medicaid system that has a proven track record for decreasing per capita costs that no other state nor any MCO can rival. Rather than scuttle it, pragmatic good sense calls for its expansion. Let's do what is best for the people of North Carolina.
Robert H. Bilbro, MD, FACP
Jun 23rd 2016 9:07 am Response: #209001 As an employee of a Western North Carolina Community Health Center and also a Certified Application Counselor, I see firsthand the lives impacted by North Carolina's rejection of Medicaid Expansion. This affects the health and well-being of real people, such as a 63 year old retiree on a fixed income - too low for ACA subsidies but categorically ineligible for Medicaid in NC; a mother making minimum wage, whose income turns out to be higher than North Carolina's ridiculously low limit for parents yet under 100% FPL so again, ineligible for ACA subsidies; or a chronically ill middle-aged man who finds it difficult to work as he has gout, cannot afford out-of pocket healthcare that could ease his pain, and therefore cannot work enough to qualify for subsidies on the exchange. These are just a sampling of the likely half of a million people who are unable to access healthcare and are suffering as a result of living in the Medicaid Gap.

As the federal agency enabled to review the NC medicaid reform proposal, I believe that you should make Medicaid Expansion a condition of any reform proposal. People who really need medical assistance, our most vulnerable, poverty-stricken populations, should have access to life-saving medical care.
Jun 24th 2016 11:57 am Response: #209005 I strongly urge you to include Medicaid Expasion in North Carolina's Medicaid Reform package. One in five adults under 65 in our state are uninsured! I know people personally who are not insured, and it's because they cannot afford insurance. We will lose $25 billion dollars in Federal matching funds between 2016 and 2020 if we do not expand Medicaid this year. Why do we choose to throw those dollars away, lose jobs, and continue the cycle of poverty?
Jun 24th 2016 9:38 pm Response: #209009 The Department of Social Services needs to be reformed before you even think about expanding Medicaid. Physicians need to have their fees increased in order to take on more patients
Jun 25th 2016 6:30 am Response: #209013 Please do you job and respect and protect the health of all North Carolinians for some of the following reasons:
Here are some bullet points for the costs of not expanding Medicaid:
1 in 5 adults under 65 remains uninsured in NC (around 500,000)
Not expanding Medicaid is already hindering job creation and economic growth because NC is not capturing billions in federal matching dollars that would otherwise flow into the state economy to make expansion more affordable.
If NC does not expand Medicaid by 2016, $21 billion in federal matching funds will be lost between 2016 and 2020.
Statewide, about half the jobs not created would be in health care (hospitals and clinics); almost half would be in other sectors such as construction or retail and wholesale trade.
Small hospitals and clinics have had to close–particularly affecting rural poor.
Non-economic reasons to expand Medicaid:
When parents are insured, their children are more likely to be insured and they are better able to care for their children.
By not closing the gap, the cycle of poverty and sickness continues. Consequences of families falling into crisis because of a lack of health coverage and a medical crisis include foreclosures and evictions- having to make the decision to pay the rent or pay for much needed medication.
Jun 26th 2016 2:49 pm Response: #209017 Yes, please expand Medicaid to cover the insurance gap left between the Affordable Healthcare Act and the ability to pay private insurance. I know far too many people who are affected by this gap, most of which are the ones that need healthcare coverage the most.
Jun 27th 2016 6:34 am Response: #209025 Helping ensure individuals are able to lead productive lives and make meaningful contributions to their communities is the wisest use of public funds. Shortages, obstacles and restrictions to care resources create risks to personal health and the community at large. Enabling investments produce measure-able benefits for both individuals and tbeir communities. I urge support for the proposed medicaid changes.
Jun 27th 2016 9:17 am Response: #209029 Do not understand why our state legislators want to dismantle one of the best delivery systems in the country, a program which other states would like to emulate. It makes no sense health-wise or fiscally.
Knox McMillan
Raleigh, NC
Jun 27th 2016 1:35 pm Response: #209033 I am an insurance professional in western North Carolina . The ACA was designed to include Medicaid expansion. Without it, rates for all persons in the state are increasing faster than if Medicaid had been expanded. Couple that with lost affordable health care for these citizens with the oblivious negative effects plus North Carolina tax dollars going unused makes Medicaid expansion a priority. Thank You - Dave Trout
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