MM Curator summary

[MM Curator Summary]: Journos celebrating the Senate passing expansion may be missing the main point that the house is still waiting on an important impact study before it plans on discussing the plan.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

OPINION AND COMMENTARY

Editorials and other Opinion content offer perspectives on issues important to our community and are independent from the work of our newsroom reporters.

Opinion

For a long time, those pushing for North Carolina to expand Medicaid thought the biggest obstacle would be getting Senate leader Phil Berger and his Republican caucus on board.

Berger and top Senate Republicans have now joined the chorus of lawmakers advocating for Medicaid expansion, introducing a major health care package Wednesday and calling it “good state fiscal policy.”

“If there is a person in North Carolina who has spoken out against Medicaid expansion more than I have, I’d like to meet that person,” Berger said at Wednesday’s press conference. “In fact, I’d like to talk to that person about why my view on this has changed, because I think this is the right thing for us to do.”

Maybe he should start with his colleagues in the House.

House Speaker Tim Moore told reporters Wednesday that it won’t be happening this year. It’s a “contentious issue” and he doesn’t “see an appetite for it right now” in his caucus, he said.

Historically, the House has not been the chamber to take the harder line on something resembling Medicaid expansion. Over the years, they’ve floated proposals that would offer coverage to more people, albeit with small premiums and work requirements.

“It’s deeply strange. It’s like the parties in the House and the Senate have switched places in the last two years,” state Sen. Jeff Jackson, a Democrat from Mecklenburg County, told the Editorial Board. “It used to be that the Senate was the problem, and the House was basically for it. And now that appears to have switched. It’s not really clear to me why that’s the case.”

Unlike the Senate, many House Republicans aren’t as convinced that it doesn’t pose a fiscal risk to the state. Some still worry what burdens might be placed on the state’s budget if the federal government were to reduce its share of the costs.

“People aren’t sure about what that’s going to do to the state, how much the state’s going to be on the hook for,” attorney and Republican consultant Larry Shaheen said. “There’s just a lot of questions that are still out there. And I think that’s kind of what’s holding them back.”

The way the legislation was presented doesn’t seem to be helping. The bill would do other things, too, like allow advanced practice nurses to practice without physician supervision. Such a policy has had mixed support among House Republicans, and is opposed by many health care providers.

House Republicans also were under the impression that nothing would move forward until a joint legislative oversight committee, which was created last year to study Medicaid expansion, presented its findings and recommendations, Shaheen said. That hasn’t happened yet.

“Jumping the gun a little bit on this probably wasn’t the wisest decision,” Shaheen said.

Only a fraction of House Republicans need to support the legislation for it to pass, technically speaking. Assuming every Democrat votes for it, only about a dozen Republicans would need to join them. There are currently 69 Republicans serving in the House.

But whether a bill actually makes it to the House floor for a vote is at the discretion of Moore and other top Republicans. It’s not uncommon for legislation to fizzle out if the majority party doesn’t enthusiastically support it.

The result: As significant as it is for the Senate to finally support Medicaid expansion, it doesn’t make much of a difference in the end. It certainly doesn’t change much for the 600,000 people still stuck in the coverage gap: unable to qualify for Medicaid, unable to afford health insurance on their own.

There’s a real cost to waiting to expand Medicaid, and it’s not just the billions of federal dollars that legislators have passed up over the years. Research suggests that expanding Medicaid could save the lives of more than 1,000 North Carolinians each year. That’s 1,000 more lives that won’t be saved if the legislature closes yet another session with unfinished business.

The path to Medicaid expansion may have cleared one major obstacle, but there’s still plenty that’s standing in the way. We can thank the House for that.

BEHIND OUR REPORTING

What is the Editorial Board?

The Charlotte Observer and Raleigh News & Observer editorial boards combined in 2019 to provide fuller and more diverse North Carolina opinion content to our readers. The editorial board operates independently from the newsrooms in Charlotte and Raleigh and does not influence the work of the reporting and editing staffs. The combined board is led by N.C. Opinion Editor Peter St. Onge, who is joined in Raleigh by deputy Opinion editor Ned Barnett and opinion writer Sara Pequeño and in Charlotte by Pulitzer Prize winning cartoonist Kevin Siers and opinion writer Paige Masten. Board members also include McClatchy Vice President of Local News Robyn Tomlin, Observer editor Rana Cash, News & Observer editor Bill Church and longtime News & Observer columnist Barry Saunders. For questions about the board or our editorials, email pstonge@charlotteobserver.com.

 
 

Clipped from: https://www.charlotteobserver.com/opinion/article261821335.html

MM Curator summary

[MM Curator Summary]: The provider-led entity plan begins July 1.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

Oklahoma adopts new system for Medicaid management

 
 

Between July 1, 2021, when Oklahoma’ Medicaid expansion went into effect, and May 2022, more than 291,000 people were added to the program’s enrollment. Currently, more than 1.2 million people are enrolled in Medicaid in Oklahoma. (Photo by Online Marketing on Unsplash)

OKLAHOMA CITY – After years of battle in the courts and at the state Capitol over how best to manage the state’s $7 billion Medicaid program, Oklahoma lawmakers and Gov. Kevin Stitt are agreed on a new structure scheduled to go into effect on July 1.

Instead of contracting with large, out-of-state insurance companies to manage the state’s Medicaid program, as Stitt had previously attempted to accomplish, the new plan ensures that Oklahoma-based companies play a role in managing care for Medicaid enrollees. However, several of those locally owned entities will still likely have to partner with large, out-of-state companies in order to provide services to Oklahoma’s newly expanded Medicaid population.

The new system is better than the original plan, health care providers say, though some remain wary of how the program ultimately will be administered.

Voters set the stage for the state to expand Medicaid eligibility to an additional 190,000 Oklahomans when they approved State Question 802 in 2020. State leaders scrambled to find a way to manage the $162 million increase the expansion was projected to cost.

Stitt responded by directing the Oklahoma Health Care Authority to award $2 billion in contracts to four private companies to manage the Medicaid program. Several medical groups, including the Oklahoma State Medical Association, filed a lawsuit. The Oklahoma Supreme Court struck down the contracts in 2021, finding Stitt did not have the authority to implement such a plan without involving the Oklahoma Legislature in the process.

Health care provider groups had objected to Stitt’s managed care plan, claiming the managed care approach did not work well when the state last attempted it in the 1990s. Lawmakers eventually switched back to a state-run system after the number of participating health are providers dwindled to a point that challenged the state’s ability to provide adequate Medicaid services.

Providers had dropped out of the Medicaid plan because they claimed the for-profit management companies, seeking to increase profits, had slashed reimbursement rates and erected other barriers to reimbursement that made participation untenable. Returning to a managed care system would likely result in the same outcome, provider groups argued.

Stitt signed Senate Bill 1337 and SB 1396 into law on May 26, hailing the new plan as one that achieves the goals he had in mind when pushing for managed care.

“I have pushed since 2020 to find a solution that improves health outcomes for Oklahomans and also protects the taxpayers from rising costs,” Stitt said.

The new plan encourages provider-led entities, such as Integris, to expand their accountable care organizations statewide, said state Rep. Marcus McEntire, R-Duncan.

“This plan puts an Oklahoma provider-led entity in the middle of that,” McEntire said when he presented the measures before the House. “The money will stop there, in state.” The new system allows Oklahoma lawmakers to more easily step in and tweak the process as needed, he said.

The Oklahoma-based companies likely will partner with larger, national companies in order to secure the financial backing needed to take on the risk of overshooting the state’s cap on expenditures, McEntire said.

Companies contracted to provide Medicaid services will be expected to achieve measurable goals and develop strategies to address health disparities, said State Medicaid Director Traylor Rains.

“While SB 1337 implements managed care, it is vastly different from where we were last January, when the health care authority offered contracts to insurance companies without legislative oversight or guardrails to protect Oklahoma’s tax dollars or our Medicaid recipients,” said OSMA President David Holden, M.D.

The latest version of the bill is the result of a more collaborative process that allowed hospitals and physicians to have some input, Holden said.

“While we still have concerns about how this program will be implemented and administered, we are grateful for the thought that has gone into this effort,” Holden said. “Looking forward, the Oklahoma State Medical Association will continue to oppose any increases in administrative fees as, ultimately, that takes tax dollars away from patient care.”

SB 1396, the Supplemental Hospital Offset Payment Program, provides $130 million annually for the Medicaid program and benchmarks hospital inpatient and outpatient services at 90% of the average commercial rate.

Between July 1, 2021, when Oklahoma’ Medicaid expansion went into effect, and May 2022, more than 291,000 people were added to the program’s enrollment. Currently, more than 1.2 million people are enrolled in Medicaid in Oklahoma.

 
 

Clipped from: https://journalrecord.com/2022/06/01/oklahoma-adopts-new-system-for-medicaid-management/