Questions linger after Medicaid presentation, DHHS asks for input

After the head of the state Department of Health and Human Services spoke for nearly an hour about her plans to overhaul Medicaid, local providers say details and questions about the future of the program remain unknown and unanswered.

“The details are really important, and the details have not yet been elicited,” MAHEC CEO and President Jeff Heck said. “So when crafting the details of this [plan], it will be very important for DHHS and our General Assembly to carefully consider the impact: Is it going to be the right system? Is it going to cover the right amount of services? Are there going to be the right incentives to take care of this population?”

For Dr. Kellett Letson, who serves as the chair of MAHEC’s OB-GYN residency program, the biggest unanswered question he had after the presentation was, “How are we going to take care of the uninsured folks in North Carolina?”

He said, in his speciality, “It’s a challenge to get folks the services they need to have the healthiest possible pregnancy and birth. If we’re really going to make a difference, we need to find a way to provide health care for all the women of Western North Carolina and Medicaid expansion was a great opportunity to make a big dent in that challenge.” In April, North Carolina became one of 18 states who said no to the Medicaid expansion available under the Affordable Care Act.

According to a recent study by the Kaiser Family Foundation, 17 percent of North Carolinians are uninsured (Heck estimates that the percentage is as high as 23 percent in WNC) and another 13 percent cited Medicaid as their health insurance in 2010-2011. Medicaid, a federal-state program, helps pay health care for the needy, aged, blind and disabled, as well as for low-income families with children.

But according to the April 22 presentation given by DHHS Secretary Alonda Wos, the problem with Medicaid in North Carolina comes down to a program she called unsustainable on two fronts. “Our costs are rising every single year and, as you well know, we spend over $36 million a day in Medicaid in North Carolina,” the former physician said. “Another reason our present system is not sustainable is how we actually practice medicine, and how we’re set up and how we’re reimbursed.”

To address these concerns, the state has put forth an overhaul of Medicaid under the moniker, Partnership for a Healthy North Carolina. The plan calls for the creation of three to four comprehensive care entities — potentially, these could be private companies — to handle physical, mental and substance abuse for the low-income and disabled people who use the health care system. However, state Medicaid director Carol Steckel said, nothing is known at this time about whether these entities will be set up regionally or in another way altogether.

The major reason behind creating these Comprehensive Care Entities, Wos explained, was to provide both physical and mental heath care to patients in the Medicaid system. “We are set up in silos,” she said. “We do not presently take care of a patient, a person as a whole. So they come into an entry point — an office, a hospital or someplace — into the greater health care system. We then take care of their physical needs. But in order for them to get mental health needs, we have to send them to a different zone, a different area — and these silos do not interact with each other.”

Speaking to local health care providers, Wos also applauded the efforts of Community Care of North Carolina. The nonprofit currently coordinates health care for most of the state’s Medicaid population, since most recipients of Medicaid are required to enroll with CCNC when they first enroll with Medicaid. In parts of Western North Carolina, Community Care of WNC coordinates care for Medicaid recipients.

Shannon Dowler, who serves as the president of the N.C. Academy of Family Physicians, asked Wos about her vision for CCNC in the new model of Medicaid.

Wos responded saying she has “great plans for CCNC. … We are attempting to create something from what CCNC is doing now to the next level,” she said. “We’re trying to structure an expansion of the model of CCNC for the entire state.”

However, concerns remain about what could happen if for-profit companies begin managing care for Medicaid recipients.

Recently, the Western Carolina Medical Society wrote a letter to Wos and state lawmakers about concerns the nonprofit physician advocacy group has about Medicaid. In the letter, WCMS President Frank Mortez and CEO Miriam Schwarz write, “We understand the significant impact Medicaid has on the state budget and can appreciate the advantage of having a known year-to-year cost for Medicaid. … However, we believe that this proposal requires more study to determine how it addresses these needs and what the impact might be on Medicaid recipients.”

Speaking with Xpress after the presentation, Heck noted, The state will not find a better collaboration in terms of partners than Western North Carolina, but they have to give us something we can work with.”

After her presentation, Wos told Xpress that the concerns she heard from providers in WNC are echoes of what she’s hearing around the state. “We’re asking them, we’re begging them to come with their ideas, their concerns, so we can do this together.”

Caitlin Byrd can be reached at, or 251-1333, ext. 140.


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