Medicaid Reform | Eastern North Carolina Now

    Conclusion

    Any serious attempt at state budget reform in North Carolina must include an examination of its Medicaid program. Costs have been soaring, and past cost-containment efforts have proven both insufficient and detrimental to enrollees' access to care. Moreover, Medicaid enrollees are merely passive participants in the program with little or no choices, and at the mercy of the whims of politicians.

    Florida's pilot Medicaid reform program provides an excellent template that North Carolina should replicate. The results would be a win-win: greater choice and superior results for Medicaid patients coupled with significant savings to hardworking taxpayers.

    Long-term care in nursing facilities represents the second-highest Medicaid expenditure in North Carolina, behind only inpatient hospital stays. And the costs of nursing care are growing rapidly. By tightening up the asset exemptions for applicants applying for Medicaid coverage of nursing facility care, the state could focus nursing care coverage for the more truly needy. Moreover, more citizens would choose private long-term care insurance, especially with a more generous tax credit. The result would be to shift coverage for this rapidly growing expense away from Medicaid, producing savings for taxpayers.

    There's a saying that's grown popular recently: "If something can't go on ... it won't." Medicaid simply cannot continue growing in cost; the only question is how it will be changed. The North Carolina General Assembly must take action to reform the program. Fortunately, Florida provides a model for how to do it.

    [1] North Carolina Division of Medical Assistance website. Available online at: http://www.ncdhhs.gov/dma/medicaid/index.htm

    [2] Ibid.

    [3] North Carolina Division of Medical Assistance, "Medicaid in North Carolina, Annual Report State Fiscal Year 2008." Available online at: http://www.ncdhhs.gov/dma/2008report/2008report.pdf

    [4] Ibid.

    [5] State Health Facts, Kaiser Family Foundation. Available online at: http://www.statehealthfacts.org/comparecat.jsp?cat=4&rgn=35&rgn=1

    [6] "Medicaid Overview," A presentation by Fiscal Research Division of the N.C. General Assembly. Available online at: http://www.ncleg.net/fiscalresearch/frd_reports/FRD_Reports_PDFs/Session%20Briefings/2009%20Medicaid%20Overview.pdf

    [7] The Joint Conference Committee Report on the Continuation, Expansion and Capital Budgets, S.L. 2012-142 (FY 2012-13 State Budget). Available online at: http://www.ncleg.net/sessions/2011/budget/2012/Revised_Joint_Conference_Committee_Report_2012_07_24_final.pdf

    [8] The Joint Conference Committee Report on the Continuation, Expansion and Capital Budgets, S.L. 2002-126 (FY 2002-03 State Budget). Available online at: http://www.ncleg.net/Sessions/2001/Budget/2002/BudgetReport9-18.pdf

    [9] Division of Medical Assistance, Medicaid 2000 Annual Report Tables. Available online at: http://www.ncdhhs.gov/dma/2000report/2000tables.pdf

    [10] Division of Medical Assistance, Medicaid 2008 Annual Report Tables. Available online at: http://www.ncdhhs.gov/dma/2008report/2008tables.pdf

    [11] Medicaid 2000 and 2008 Annual Report Tables, Ibid.

    [12] Community Care of North Carolina website. Available online at: http://www.communitycarenc.com/about-us/history-ccnc-rev/

    [13] Ibid, available online at: http://www.communitycarenc.com/about-us/

    [14] L. Allen Dobson Jr, MD, FAAFP; Denise Levis Hewson, RN, BSN, MSPH, "Community Care of North Carolina--

    An Enhanced Medical Home Model", North Carolina Medical Journal, May/June 2009, Volume 70, Number 3. Available online at: http://www.communitycarenc.com/media/publications/north-carolina-medical-review.pdf

    [15]Ibid, available online at:: http://www.communitycarenc.com/about-us/update-archive/results-update/

    [16] Al Lewis, "Is North Carolina Medicaid the Healthcare Industry's Solyndra?" posted at The Health Care Blog in Feb. 2012. Available at: http://thehealthcareblog.com/blog/2012/02/21/is-north-carolina-medicaid-the-healthcare-industrys/

    [17] MACPAC (Medicaid and CHIP Payment and Access Commission), Report to the Congress on Medicaid and CHIP, June 2012. Table 8, Medicaid Spending Per Full-Year Equivalent (FYE) Enrollee by State and Eligibility Group. FY 2009. Found on pages 126-127. Available online at: https://docs.google.com/viewer?a=v&pid=sites&srcid=bWFjcGFjLmdvdnxtYWNwYWN8Z3g6MjQxNTdlMDZkMzhkNjgyMA . Southeastern neighbor states in this reference include: South Carolina, Virginia, Tennessee, Georgia and Florida.

    [18] Ibid.

    [19] Annual state budget documents for each year from FY 2001-02 through FY 2012-13

    [20] Medicaid 2000 Annual Report Tables, Supra.

    [21] Medicaid 2008 Annual Report Tables, Supra.

    [22] Stephen Moss, "Long-Term Care Financing in North Carolina: Good Intentions, Ambitious Efforts, Unintended Consequences," a Policy Report prepared for the John Locke Foundation. Jan. 2008. Available online at: http://www.johnlocke.org/site-docs/policyreports/NC_LTC_finance.pdf

    [23] Ibid.

    [24] North Carolina Division of Medical Assistance website, available online at: http://www.ncdhhs.gov/dma/medicaid/ltc.htm

    [25] "Medicaid Eligibility for Nursing Home Benefits", N.C. State University Family and Consumer Sciences. Available online at: http://www.ncbar.org/download/planningyourestate/medicaid_eligibility.html

    [26] "Deficit Reduction Act of 2005: Implications for Medicaid," Kaiser Family Foundation Policy Brief, Feb. 2006. Available online at: http://www.kff.org/medicaid/upload/7465.pdf

    [27] Medicaid 2008 Annual Report Tables, Supra.

    [28] Division of Medical Assistance, 2004 Annual Report Tables. Available online at: http://www.ncdhhs.gov/dma/2004report/2004tables.pdf

    [29] Medicaid 2008 Annual Report Tables, Supra.

    [30] Moss, Supra.

    [31] "A Medicaid Cure: Florida's Medicaid Reform Pilot," Foundation for Government Accountability. Nov. 2011. Available online at: http://www.floridafga.org/wp-content/uploads/Combined-Medicaid-Reform-Pilot-Nov-2011.pdf

    [32] Ibid.

    [33] Ibid.

    [34] Moss, Supra.

    [35] The credit is limited to those in households earning less than $100,000 per year (married filing jointly), or singles earning $60,000 annually. G.S. 105-151.28, available online at: http://www.ncleg.net/gascripts/statutes/statutelookup.pl?statute=105