Why Legislators Should Think Twice About House’s Medicaid Reform Proposal

A House health committee yesterday approved a proposal for reforming the state’s $13 billion Medicaid program. According to reports, the newly-revised reform plan would “be built on the foundation of the state’s Community Care of North Carolina networks, which coordinate care for most Medicaid patients.”

CCNC has been cited by many as a model of delivery that has saved NC’s Medicaid system billions over the years. Critics, however, have panned the reports purporting to show such significant cost savings generated by the CCNC model. Closer evaluation shows that there are many questions that need to be answered when evaluating the effectiveness of a CCNC-type model. As I wrote more than a year ago:

If CCNC is producing such significant cost savings for Medicaid expenses, why are key categories of Medicaid expenses so much higher here than for North Carolina’s Southeastern neighbors? The group with the highest rate of CCNC enrollment is children, yet North Carolina’s average Medicaid expenditure for children is 15^th highest in the nation and a whopping 27 percent higher than the average of our Southeastern neighbors. Furthermore, the other eligibility group to have CCNC oversight the longest is the adult population, of which North Carolina’s Medicaid expenses are 12^th highest in the nation and 16 percent higher than regional states.

Serious questions remain – and should be answered – about transitioning NC’s Medicaid program to a CCNC-style of delivery. And even more questions need to be raised and addressed if state legislators are still considering an Accountable Care Organization model for Medicaid.