North Carolina's Senate, House and governor are getting closer to an agreement on overhauling the state's Medicaid program. Senate leaders announced a new plan Wednesday that's similar to what House leaders and Governor McCrory want. But there are still two key differences to work out.
The first sticking point is who will eventually take responsibility for managing the state's Medicaid program: insurance companies or groups of doctors and hospitals?
The insurance companies in this case are often called managed care organizations, and the groups of doctors and hospitals are called accountable care organizations. Here's the way Governor Pat McCrory framed the issue on WFAE's Charlotte Talks this week:
"Right now there's a major battle within the medical community between managed care systems and accountable care organizations - on whether you want out-of-state managed care, some for profit, to come in and take over your system, or do you want to try to work within the system you have," he said.
McCrory wants to go with the groups of doctors and hospitals, and the House passed a bill two weeks ago to start the process of giving those groups more responsibility.
The Senate had favored putting insurance companies in charge. But the Senate's new plan leaves the door open for groups of doctors and hospitals too. It's unclear if that's enough to satisfy the governor and House leaders.
The second key difference between the plans is whether the Medicaid program will remain within the state Department of Health and Human Services. The Senate wants to create a new department to house Medicaid, and this comment by Sen. Louis Pate during a committee meeting explains why.
"We are working very diligently to see that Medicaid becomes predictable to the state of North Carolina," he said.
Medicaid cost overruns have been huge problems for the Department of Health and Human Services, so Sen. Pate and his colleagues want to see if a new department can do a better job.
Governor McCrory and House leaders, at least to this point, have preferred addressing the budgeting problems within the Department of Health and Human Services.