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Questionnaire NameNorth Carolina's Medicaid Reform Demonstration
DescriptionNorth Carolina requests a new section 1115(a) demonstration to transform and re-organize North Carolina's Medicaid and NC Health Choice programs. The state intends under the requested demonstration to reform the Medicaid program through statewide managed care plans, transforming primary care medical homes (PCMHs) to person-centered health communities (PCHCs), integrating behavioral health and physical health, and lastly, by allowing managed care entities to provide long-term services and supports (LTSS) for Medicaid only individuals. The federal comment period will be open from June 20, 2016 through July 20, 2016.
Response FromID: #208997 on Jun 22nd 2016 1:11 pm
North Carolina's Medicaid Reform Demonstration

North Carolina's Medicaid Reform Demonstration

We encourage the public to submit their comments on Medicaid.gov as they relate to demonstrations open for public comments. In support of transparency and open government, all public comments received are immediately posted and are in the public domain. Center for Medicaid and CHIP Services staff will review all public comments posted and we reserve the discretion to delete comments that are generally understood as any of the following: obscene, profane, threatening, or otherwise inappropriate.

Refer to the Application

Open for Public Comment – 6/20/16 – 7/20/16

Please provide your comments here and/or attach below:

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
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