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NC Leaders In Agreement On Overhauling Medicaid Payment Model


North Carolina is poised to overhaul how it pays for doctor's visits and other physical health services under Medicaid. Governor Pat McCrory, state House and Senate leaders agree on that front, although they still need to work out differences in their broader plans for Medicaid.

Under the current Medicaid system, doctors and other providers get paid after they treat patients.

In the new model, the payment would shift to the front end. The state would put some organizations or businesses in charge of managing the program. They'd get all the money up front, and they'd be on the hook if they go over budget.

State Senate leaders have made it clear that's the model they want. A House committee endorsed legislation yesterday that included that model. And the McCrory administration is pleased with that legislation.

Mardy Peal is senior advisor to the state Secretary of Health and Human Services.

"The House envisions that by the year 2020, the majority of Medicaid patients in the state would be cared for by a provider who was responsible for their total cost of care," Peal said.

That makes the state's budgeting much easier. And it protects the state from having to shell out money for huge cost overruns, which have become a standard part of North Carolina's Medicaid program. 

But it could also lead to some people losing services they rely on. That's happened on the mental health side of the program since it switched to this model.

Bottom line, Governor McCrory, the House and Senate still need to work out the details. For example, McCrory wants groups of doctors and hospitals to be in charge, while some Senate leaders favor what are basically insurance companies.

The full House will take up legislation on this next week.