The novel coronavirus, COVID-19, presents an unprecedented challenge to our state. North Carolina health insurers are working hard to address the crisis.
Common Questions and their Answers
- North Carolina’s Medicaid program has been plagued by annual shortfalls that often run into the hundreds of millions of dollars, yet Medicaid recipients aren’t getting the outcomes they deserve.
- Over the last five years, annual shortfalls in the North Carolina’s Medicaid program have averaged nearly $350 million.
- North Carolina’s Medicaid program cost $13.3 billion last year, of which $3.4 billion was paid by North Carolina taxpayers. Despite the state’s large investment in Medicaid, North Carolina taxpayers still aren’t getting the value they deserve.
- North Carolina is one of the few states that still relies on a fee-for-service Medicaid system that pays doctors primarily for the volume of services they provide rather than for quality care and patient outcomes.
- Currently, 39 states have adopted Medicaid reforms that shift financial risk from taxpayers to organizations that are paid a fixed fee set by the state to support the health care needs of Medicaid recipients and are accountable for meeting quality and other performance measures.
- We urge North Carolina lawmakers to modernize Medicaid. We advocate systematic changes that deliver budget predictability and better health outcomes for Medicaid recipients.
- We support legislation that shifts financial risk away from taxpayers by allowing traditional managed care plans, as well as plans offered by health care providers, to compete in the North Carolina Medicaid market.
- Allowing both traditional managed care and provider-led health plans willing to assume financial risk to care for Medicaid recipients would allow North Carolina to better control costs and prevent crippling budget shortfalls.
- A wider range of plan options will provide choice for Medicaid recipients and needed competition in the market that will raise the bar on delivering health care improvements for Medicaid recipients while also helping to control costs.
- Medicaid recipients can expect to have the same, or better, quality of care with managed care.
- Managed care plans offer programs and services focused on the overall health of the individual person. As a result, a far greater emphasis is placed on preventative care and helping patients pro-actively manage their chronic conditions. With managed care, patients often have access to additional benefits like incentive programs for pre-natal care and weight loss. These types of initiatives are often not allowed in fee-for-service Medicaid programs due to rigid rules and lack of funding.
- First, North Carolina Medicaid recipients can expect to have the same, or better, quality of care under a modernized Medicare system.
- Plans provided by traditional managed care companies and health care providers offer programs and services focused on the overall health of the individual person. As a result, greater emphasis is placed on preventative care and helping patients pro-actively manage their chronic conditions.
- Yes, currently 39 states have adopted Medicaid reforms that shift financial risk from taxpayers to organizations that are paid a fixed fee set by the state to support the health care needs of Medicaid recipients.
- Florida is one state that has modernized its Medicaid program to the benefit of state taxpayers. Its plan allows Medicaid beneficiaries to choose from a range of plans offered by traditional managed care companies and health care provider networks.
- The program is expected to save Florida taxpayers up to $900 million a year. In addition, a University of Florida study found that Florida Medicaid recipients enrolled in the new plans had improved access to health care and higher satisfaction with their physician than under the old state-run fee-for-service program.
- Other states that have implemented similar reforms have seen cost savings of between 0.5 percent and 20 percent according to a study by The Lewin Group, a health care consulting firm.