This week, the general assembly passed a bill that would make some major changes to the state's Medicaid program. Medicaid is the government-run health insurance program serving low-income residents.
Gov. Pat McCrory is expected to sign the bill. So what differences can people enrolled in Medicaid expect? WFDD's Keri Brown broke down what we know so far in an interview with Sean Bueter.
Here are the basics:
What's going on here? What did the legislature vote to change?
The bill moves the state's Medicaid system from a fee-for-service model to a managed care model, so basically the payment structure changes. Under the current system, doctors get paid after they provide services. But in the new system, the state would give insurance companies and groups of doctors and hospitals a set budget up front based on who they serve.
If they go over that amount, they cover it, not the government. But if they save money, they turn a profit, and there are limits on that amount.
Is the goal here is to privatize Medicaid?
Yes, it's essentially privatizing North Carolina's $15 billion Medicaid program. It's a change that doctors and hospitals have been fighting for months.
What advantages do supporters of the change see in doing it this way?
Supporters and some Republican lawmakers say the changes will allow the state to control Medicaid growth. There were program budget shortfalls from 2010 to 2013 ranging from $335 million to $600 million dollars. But one of the problems had been estimating how much the federal government would kick in each year.
Supporters say it will also provide an avenue for patients to get better care. Recipients will actually choose which health plan they want, which is different.
And some supporters say the changes even provide a path to Medicaid expansion in the future.
What are the critics saying?
They say they aren't convinced that there are safeguards in place to make sure patients are getting high-quality care, and that insurers will be inclined to pay for fewer services, rather than ensure patients get all the treatments they need.
They also say taxpayer dollars shouldn't be contributing to profits for insurance companies based on their ability to limit and cut services to low-income people.
There are a lot of complex ideas here: boil it down for us. What's the bottom line for consumers?
The payment structure will change but there's still a lot to sort out. For example, what standards will be in place to measure quality and accessibility of care?
It's important to point out that people will see some differences upfront (like picking their insurance plan), but there are a few groups exempt from the changes, like those who qualify for both Medicaid and Medicare.
And this won't happen right away. Even after Gov. McCrory signs the bill, the federal government still has to approve the changes, which could take up to two years. And full implementation could take another year or two after approval comes down.
*Follow Keri Brown on Twitter @kerib_news.
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