Medicaid management nonprofit faces closure

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Budget proposes closure of network also operating in WNC

An award-winning system of managing Medicaid patients in North Carolina would be dropped under the state Senate’s budget proposal.

Community Care of North Carolina, a nonprofit with 14 networks across the state — including Western North Carolina — would lose its contract with the state under the Senate’s plan.

The proposed elimination of the nonprofit network is part of the Senate’s plan to remove Medicaid management from the state Department of Health and Human Services and create a new agency to handle the program, as noted in its budget document.

Community Care of Western North Carolina, which has an office in Asheville, serves eight WNC counties: Buncombe, Henderson, Madison, McDowell, Mitchell, Polk, Transylvania and Yancey, according to its website. It serves 64,342 Medicaid enrollees, according to July 2013 figures, with an additional 12,000 enrolled in other programs.

Officials there referred questions to the spokesman for Community Care of North Carolina, Paul Mahoney, who said the organization would have limited comment other than to say the nonprofit continues to support Gov. Pat McCrory’s Medicaid reform plan; that there must be “robust data to improve quality and manage care effectively” and that the organization will “continue to work with policymakers on a North Carolina approach to Medicaid reform.”

Dr. Shannon Dowler

Dr. Shannon Dowler

However, Dr. Shannon Dowler, chief medical officer of Blue Ridge Community Health Services and chair of the board of the N.C. Academy of Family Physicians, was less restrained.

“I believe the Senate’s budget would have a devastating effect on the health of North Carolina,” she said, moments after seeing patients in the Arden office of the private, nonprofit community health center, which has five offices in Western North Carolina.

Her practice works closely with Community Care of Western North Carolina, which uses a physician-led care management model to make sure that patients on Medicaid are getting the appropriate care.

If the state goes to a managed-care system, Dowler said she predicted that it would limit costs to the point that services and reimbursements would be reduced, leading to fewer practices accepting Medicaid. If that were to happen, patients getting less access to care would like end up in hospital emergency rooms.

There are “so many better options” to handle the state’s Medicaid patients — and mainly that involves reinvesting with Community Care of North Carolina and improving that system, Dowler said.

Medicaid, the health-insurance program for the poor, covers an average of about 1.8 million North Carolinians, according to state statistics. The total cost of the program in 2013 was about $13 billion (about double the price tag from 2003); the state’s share was about $3 billion, with the federal government picking up the rest.

The Senate’s move comes after McCrory and DHHS presented a reform plan that keeps Community Care of North Carolina and its regional networks while seeking improvements in the system — which, as physician and DHHS Secretary Aldona Wos noted is “no longer affordable in light of the state’s fiscal outlook and other pressing priorities for state funds such as education.”

Despite the Medicaid’s increasing costs, North Carolina has the lowest increase in the cost of caring for the Medicaid populations compared to all the other states, Dowler notes — and that, she says, is because the state does such an excellent job in managing the Medicaid population.

In fact, Community Care of North Carolina won a prestigious Annie E. Casey Innovations in American Government Award in 2007 from the Ash Institute at the Kennedy School of Government at Harvard University for “its work in improving health care services for Medicaid and other populations,” according to Community Care’s website.

The issue is far from decided. The House has yet to approve its budget — though it is expected to vote on the measure this week — and any differences between the Senate and House budgets would have to be reconciled before a bill becomes law.

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Tracy Rose

Tracy Rose is a contributing reporter with Carolina Public Press. Contact her at tracy.b.rose@gmail.com.

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