Health agency leaders faced a crowd of skeptics sprinkled with voices of hope Wednesday as they sought to sell Gov. Pat McCrory's plan to revamp the government program that provides 1.5 million poor children and disabled adults with health care.
Health and Human Services Secretary Aldona Wos and Medicaid Director Carol Steckel held a question-and-answer session on the McCrory administration's plan to have private companies run a big chunk of the state's $13 billion a year Medicaid program.
The proposal will require approval from the federal government and the state's General Assembly to meet a July 2015 target.
It would have three or four statewide managed-care companies or other entities deliver medical, mental, and dental care for a set price. The private groups would have to pay for expenses beyond the state's monthly payments per patient, providing an incentive for them to improve patient health and giving more cost certainty to the state, which has dealt with perpetual overruns, Wos said.
The goal is to treat the sick comprehensively, cut down on repeat or unneeded treatments, while reducing the administrative complexity that steer many private-practice physicians from taking on Medicaid patients, Wos said. One physician said he hoped the changes would include simplifying the bureaucracy it takes for doctors to get paid.
"Being efficient does not mean providing less service. Being efficient will actually allow us to give the right service to the right person at the right time. Because right now some people get too much of a good thing and some people don't get enough," Wos said.
Wos emphasized that the state would launch a single, Internet-based Medicaid billing system by July, replacing several claims-processing systems.
But skeptics, who ran the spectrum from university physicians to a man named Ed who said his son suffered from schizophrenia, questioned why they should believe the health program for the elderly and disabled would be protected after McCrory and the General Assembly refused to expand Medicaid coverage earlier this year.
About 500,000 low-income North Carolinians would have qualified for government health insurance under the expansion. The federal government said it would cover 100 percent of the state's expansion costs through 2016 and at least 90 percent thereafter.
"How is the public to trust, and how are we to trust, that the changes that are going to be made are in the best interests of the quality of care for the poor?" asked Duke University medical school researcher Perri Morgan, whose question drew applause.
Wos and Steckel said Medicaid expansion was off the table this year. They avoided questions about why they believed managed-care companies would improve on the state's home-grown, non-profit Community Care of North Carolina managed-care doctor networks.
"Why do we think that this will improve the system over what we already have with Community Care of North Carolina," asked Dr. Genie Komives, a family doctor in Hillsborough.
CCNC saved the state nearly $1 billion between mid-2006 and mid-2010, according to an independent actuary's report in 2011. But the Medicaid program still has chronically outstripped its funding. The state's Medicaid shortfall was $418 million last year and nearly $248 million through June 30.
Wos and Steckel said they wanted to build on CCNC's successes and improve on it.
"Everybody recognizes the system needs to go to the next level. That there are significant gaps in the system," Steckel said. "That's what our intent was, not to make it a lucrative field for out-of-state, Wall Street" companies.