As expected, a state legislative oversight committee did not hold a key recommendation vote Monday on a controversial Medicaid reform bill.
Rep. Craig Horn, R-Union, a co-chairman, said at the start of the Reform Evaluation Oversight Committee meeting in Raleigh it was “on purpose” that the proposed bill was not on the agenda.
He said that there were several reasons for the second delay, such as several new committee members not being prepared “to vote on this substantial recommendation.” Horn mentioned initiatives being pursued that could result in alternative Medicaid reform bills, with “some conflicting” language expected in those recommendations.
Rep. Donny Lambeth, R-Forsyth, said Friday that a separate Medicaid reform bill is being prepared that he hopes will strike a compromise between what House and Senate leaders want from reform.
Horn also said the committee is awaiting a state auditor’s report that’s expected to be released in March.
At least three state audits since May 2013 have raised questions about the ability of the N.C. Department of Health and Human Services to operate elements of the state Medicaid program in a financially efficient, transparent and timely manner. Last fall, state health Secretary Dr. Aldona Wos said the program had a $64 million surplus for fiscal 2013-14 — a claim questioned by several legislators.
Horn stressed that the proposed bill “is not off the table, just not on today’s agenda.”
The state Medicaid program was estimated to cost $13.6 billion in fiscal 2013-14 and cover more than 1.85 million North Carolinians.
The proposed bill calls for drastic changes in Medicaid oversight to create more accountability and transparency.
The main element is creating an independent authority within the DHHS managed by a paid, seven-member board of directors. The bill was made public Jan. 15 at an oversight subcommittee.
The proposed bill would keep the Division of Medical Assistance and N.C. Health Choices and their staffs nominally within DHHS. A 2014 Senate recommendation would have created a new entity under which those programs would operate.
The independent authority and the bill have the support of several key Senate leaders, such as Sen. Ralph Hise, R-McDowell, and a committee member.
Medicaid reform has become one of the biggest sticking points among state Republican leaders and Gov. Pat McCrory, who has declared from the first day in office that the program is broken.
Senate leaders tout privatization, including hiring out-of-state insurers, as the best way to fix it.
Meanwhile, House leaders, Wos and McCrory prefer having North Carolina-based providers and health care systems involved in accountable care organizations that carry a larger risk-reward expenditure role.
Rep. Verla Insko, D-Orange, who is not a committee member, said she has heard from health care provider groups “that are very worried about the state budget shortfall.”
“If we don’t make progress on this in 2015, DHHS may move to implement ACOs incrementally — as they already are,” she said.