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Medicaid Transformation Is On Its Way To North Carolina

Lilly Knoepp
There are 1.6 million people on Medicaid in North Carolina. Fifty-seven percent of them are women and children says Dave Richards, deputy secretary of NC Medicaid.

 More than 2 million people in North Carolina will be impacted when changes to the state’s Medicaid program take effect.


At the end of last year, North Carolina finalized terms to move to a managed-care system for Medicaid in the state. The first regions of North Carolina where those changes will be rolled out will be announced at the beginning of February says Deputy Secretary for North Carolina Medicaid Dave Richards.


“It’s really important that people understand what we are changing in medicaid so that beneficiaries, providers and our community partners understand the move to managed care,” says Richards. In those two regions, Medicaid transformation will be rolled out in November 2019. The rest of the state will see changes in February 2020.


Right now, Medicaid pays hospitals and service providers after a patient visits them.  Under managed care, the state will give a set amount of funds to Medicaid providers at the beginning of the year. There will be 4 state plans and 12 regional plans available, as well as, a tailor-made plan later on.


Richards says managed care will make sure that Medicaid won’t go over the state’s almost $4 billion dollar budget for the program. Critics say that can hurt quality of care and that a new payment system will cause a lot of headaches for healthcare providers.    


The second big change coming to Medicaid in North Carolina are programs that will pay for services that are social determinants of health – which Richards explains are conditions outside of the body that impact health, like housing, transportation, and access to healthy foods.


“This is really the first time that that waiver has been granted in the country and it’s a significant amount of money - it’s $650 million dollars,” says Richards.


While North Carolina Medicaid is transforming, it is not expanding under the Affordable Care Act.Thirty-six states have or are in the process of opting into the federal program - North Carolina isn’t one of them.


“What we are doing in Medicaid transformation , we really think is ground breaking and we really think it will change the way that we provide health in North Carolina but what we know is that if you don’t have an insurance card and you don’t have access to healthcare to get that then all of the good things that we are doing,” says Richards.


Richards adds that the number of people don’t have health insurance would go down if Medicaid were expanded in the state.


Lilly Knoepp serves as BPR’s first fulltime reporter covering Western North Carolina. She is a native of Franklin, NC who returns to WNC after serving as the assistant editor of Women@Forbes and digital producer of the Forbes podcast network. She holds a master’s degree in international journalism from the City University of New York and earned a double major from UNC-Chapel Hill in religious studies and political science.
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