Highlight on North Carolina: New governor forges ahead with Medicaid expansion plans

Newly elected North Carolina Gov. Roy Cooper (D) recently announced that he will take executive action to expand Medicaid in defiance of a state law. The governor’s plans will certainly set up a confrontation with the Republican-dominated state legislature. In an address at an economic fourm, the governor said he would file an amendment to the state Medicaid plan by week’s end. Under the governor’s proposal, North Carolina would allow hundreds of thousands more people to sign up for health insurance.

North Carolina has roughly two weeks to expand Medicaid, as described in the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148), and have the plan be approved by federal officials. With President-elect Trump soon to take office, there is no guarantee that Medicaid expansion under the ACA will continue. The North Carolina legislature has refused to expand Medicaid, going as far as passing legislation in 2013 that barred the executive branch from expanding the program. Gov. Cooper has argued that the legislation undermines the executive branch in its “core” responsibility of ensuring the “health of the people.”

Republican state lawmakers disagree, equating any Medicaid expansion as a tax increase. Gov. Cooper noted that Medicaid expansion could boost the economy, as the billions in monies from the federal government would benefit up to 650,000 residents. North Carolina’s share of Medicaid expansion cost would be about 5 percent, rising to 10 percent by 2020. The governor is encouraging the state’s hospitals to cover the state’s share of Medicaid expansion cost. North Carolina’s Medicaid has been in the black for the past three years. In 2015, state lawmakers and the previous governor agreed to rework the system, replacing a fee-for-service structure with one in which insurers receive a fixed monthly amount to care for patients.



Medicaid plans as shifting as the sands, states weighing options

State Medicaid programs continue to change in response to various factors, from Florida changing its hepatitis C treatment policy to favor patients, to non-expansion states considering the financial impact of potential options. Louisiana just began enrolling the newly eligible this week, and the state projects that many more will seek coverage. South Dakota’s governor is employing some creative techniques to argue that expansion will not cost the state additional funds, and North Carolina is trying to shift plan oversight to outside organizations.

Florida and Hepatitis C

Florida is now providing vital medications to Medicaid patients with hepatitis C at an earlier stage of the disease. In the past, patients have only been offered the drug when they were at fibrosis level three or four, which indicates a high level of scar tissue in the liver and is sometimes the point where patients are in need of a transplant. These drugs are expensive to the program, costing as much as $31,000 each month. Florida amended its program criteria on June 1, 2016, removing the fibrosis level from the criteria.

Louisiana, welcome to Medicaid expansion

Louisiana opened its enrollment process to those newly eligible under the program’s expansion on June 1. The Department of Health and Hospitals (DHH) projects that about 375,000 individuals will eventually receive coverage under the expansion, although the department has been communicating with about 175,000 people about qualification. It is uncertain what effect this will have on other Louisiana health issues, such as doctor training programs. Budgetary problems, including proposed cuts to hospitals, is causing residents to go out of state for training- where they are likely to stay. Safety net hospitals, which treat many poor and uninsured patients, are particularly concerned about the reduction in funding as the state legislature attempts to resolve a budget shortfall.

Utah’s expansion comes with much less fanfare

After Utah’s legislature decided to pass a very reduced expansion plan, one that Democrats bemoaned as a “cruel trick” and “fiscal insanity,” little has been said about the matter–an extreme contrast to years of fighting over the plan of action. The plan will provide coverage to somewhere around 10,000 citizens, a reduced estimate from the original 16,000 tally. Officials expect that the money to be invested in the expansion will not stretch far to cover very many residents due to the high health costs associated with those who have gone without care. Although there has been an opportunity for hearings and public comment, the state has received little input. Some blame the timing of hearings, which would require those interested to come in during a workday, while others believe that the public feels that the legislature is uninterested in their opinions.

North Carolina seeks waiver

North Carolina is requesting that CMS allow it to transfer Medicaid oversight to three managed care organizations and provider-led entities. Although a representative felt that the state provider community has embraced the plan, the state legislature is less than united. The state Senate recently unanimously rejected House changes to its reform bill, which would require the state agency to provide progress reports and disclose a work plan for changes to be made to state health care programs.

South Dakota wants to expand Medicaid without spending more money

South Dakota Governor Dennis Daugaard (R) believes that he can figure out how to expand the state’s Medicaid program to cover about 50,000 more citizens without increasing state spending. Although he believes the math can work if the federal government shoulders more Medicaid costs for Native Americans in the state, the governor is concerned about pushback from the legislature.

Highlight on North Carolina: State entities join to build mental health workforce

North Carolina local management entities (LMEs) and managed care organizations (MCOs) announced a joint workforce-development initiative to offer training resources to professionals on the front lines of providing services to individuals with disabilities. Cardinal Innovations Healthcare, Smoky Mountain LME/MCO, and Trillium Health Resources will offer both raining and evidence-based curricula to direct support professionals through DirectCourse.

Workforce development

CMS standards for direct support professionals focus on improving the quality of services for individuals with intellectual and developmental disabilities. The curricula offered by the initiative were created to align with the CMS competencies adopted in the NC Innovations Waiver. The waiver was created to help the state’s Medicaid beneficiaries with intellectual or developmental disabilities live a more independent lifestyle. Under the waiver, LME/MCOs receive a set amount of money each year to help these individuals get specialized services. The curricula offered through the initiative includes: College of Direct Support & College of Frontline Supervision and Management; College of Employment Services; College of Personal Assistance and Caregiving; and College of Recovery Community and Inclusion.

Increasing mental health workforce

Recent recommendations from members of the state’s Task Force on Mental Health and Substance Abuse focus on increasing the number of mental health providers in the state. The Task Force noted that about 60 counties in North Carolina have no psychiatric provider and suggested expanding the scope of practices for nurses, as well as education loan-repayment programs to make mental health treatment more accessible. The issue reflected in the governor’s budget, with $30 million directed toward enhancing case management for those with mental health disabilities and creating transitional housing.

North Carolina Food Safety Rules to Tighten

Anyone who has suffered a bout of food poisoning can attest to how important good food safety practices are. Symptoms include nausea, vomiting, diarrhea, fever and chills, and in rare cases, it can even cause death. Restaurant patrons are not the only ones to suffer when bad practices are used, considering that one outbreak of foodborne illness costs a restaurant an estimated $75,000. To protect both patrons and restaurants, North Carolina plans to adopt food safety regulations issued by the federal Food and Drug Administration (FDA), which are more stringent than the current state laws in place.

The FDA’s 2009 Food Code is supported by an array of professionals in the food industry, academics, regulators, government agencies and consumer groups. The Code is updated every four years to reflect the most recent scientific developments and is created in partnership with physicians, scientists, industry representatives and academics. The Code equips food service workers with thorough training methods and supporting documentation and allows national chains to adopt uniform food safety measure in all their locations.

The Code concentrates on diminishing risks connected to improper temperatures for both storing and cooking food as well as those associated with equipment and utensils that have been contaminated. Other areas of focus include ensuring food comes from safe sources and encouraging employees to utilize good hygienic practices. One particular practice of concern is making certain that ill employees do not come to work when they are exhibiting particular symptoms of concern.

The implementation of the new Code is estimated to cost restaurants nearly $5 million in its first four years; however, officials stress that the costs will be offset by the savings restaurants will experience by the lack of foodborne illness incidents. The FDA Food Code is scheduled to take effect on September 1st of this year.