North Carolina providers, insurers may compete for managed Medicaid

A political and philosophical brawl among providers, insurers and policymakers in the Tar Heel State is reaching a possible resolution as North Carolina's Legislature attempts to coalesce around a bill that would overhaul the state's Medicaid program.

Republican Gov. Pat McCrory has made Medicaid reform one of his top priorities since he entered office in 2013. North Carolina's two Republican-led chambers have disagreed sharply over how to accomplish that, but legislators say they are close to nailing down a final, compromising pact.

“It's been a hot debate,” said Chip Baggett, the top lobbyist for the North Carolina Medical Society, which represents physicians. 

North Carolina House Bill 372 lays the groundwork for the state's Medicaid reform. In an effort to “ensure budget predictability,” North Carolina's Medicaid program would move full-bore to managed care. The state currently relies on a program called Community Care of North Carolina, which is a group of 14 provider-based community networks that uses a patient-centered medical home model. The state reimburses CCNC providers on a fee-for-service basis, but it also pays the networks a monthly per-member fee to coordinate patient care.

CCNC covers a majority of the state's Medicaid population, and it has been recognized nationally for its patient-care methods. It also appears to save the state money, according to a report from North Carolina's Office of the State Auditor released Thursday. CCNC saved North Carolina $312 a year for every nonelderly Medicaid patient from 2003 to 2012, which equates to more than $400 million a year.