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North Carolina Recognized for Innovations in Medicaid Program; state inches closer to expansion

North Carolina’s Medicaid program received a 2022 Medicaid Innovation Award presented by the Robert Wood Johnson Foundation and the National Academy for State Health Policy. The nonpartisan award recognizes states for demonstrating creativity, leadership and progress in their Medicaid programs despite significant public health challenges in recent years.

Selected by a panel of expert advisers, Medicaid Innovation Award recipients are Medicaid agency leaders who implemented or enhanced initiatives that demonstrate innovative and unique approaches to improving the health and lives of Medicaid enrollees. 

 North Carolina received the award for its work on improving access to care. Specifically, NC Medicaid was recognized for developing a maternal/perinatal telehealth policy during the COVID-19 pandemic that provided telehealth and home visit care to patients; provided reimbursement to perinatal providers for remote blood pressure monitoring, physiological monitoring and lactation services; and conducted postpartum depression screenings by video, phone and online portal messaging.

“The COVID-19 public health emergency challenged our teams to look at innovative ways to continue to provide important care to our beneficiaries,” said Deputy Secretary for NC Medicaid Dave Richard. “Our focus, as a state, on maternal health and improving the outcomes of pregnant women and their children has intensified in recent years. Through our response to COVID-19 we were able to fast-track innovative ways we can care for patients across the state.”

 “Medicaid enables states to develop tailored, creative solutions to local challenges, and when faced with an unprecedented pandemic, Medicaid leaders dug deep to develop innovative approaches to care,” said Tara Oakman, interim managing director at the Robert Wood Johnson Foundation. “While it remains a difficult period for Medicaid programs, all states can learn from successes in other states in improving Medicaid access, care delivery and equity.”

NCHA releases Expansion Compromise 

 Over the weekend, The N.C. Healthcare Association released a compromise proposal deal and presented it to both Senate and House leadership as well as Governor Roy Cooper’s Office. 

In the proposal, health systems and hospitals would fund a majority of the state’s share of the expense of expanding Medicaid for 600,000 North Carolinians at an estimated cost of over $550 million per year, on top of absorbing a minimum projected loss in revenue of more than $700 million as a result of certificate of need (CON) law modifications involving ambulatory surgery centers. The proposal also suggests that the state repeal CON law for psychiatric inpatient beds and chemical dependency beds. The association is making this proposal in an environment where its members continue to be pressured by elevated costs, with most hospitals reporting year-to-date negative financial margins. 

“NCHA and our members have urged elected leaders to expand Medicaid to improve the health of our neighbors and communities for over a decade. In fact, our members are offering to invest over $550 million per year to make expansion a reality,” said NCHA Board Chair Roxie Wells, MD, president of Cape Fear Valley Health Hoke Hospital. “In an effort to get stalled negotiations moving, and in response to Senator Berger’s and Governor Cooper’s requirement that Medicaid expansion be coupled with certificate of need reform, our board of trustees has made the difficult decision to propose certificate of need law reforms. CON law changes could threaten the survival of community hospitals if they are not implemented carefully. We are putting a lot of trust in legislative leaders to do this correctly. If this policy damages access to local healthcare services, we hope that government leaders will find the resources to preserve crucial healthcare services and facilities, including safety-net services that North Carolinians rely on.”  

North Carolina is one of only a dozen states that has not expanded Medicaid. The ability of health systems and hospitals to pay for most of the state’s share of the cost of expansion hinges on the General Assembly passing legislation that includes the Healthcare Access and Stabilization Program (HASP). HASP is a program available through the federal Centers for Medicare and Medicaid Services (CMS) that would help ensure hospitals have the financial fortitude to care for Medicaid patients. On average, hospitals receive only 72 cents for every dollar spent on providing care to Medicaid and uninsured patients, amounting to a $2.3 billion dollars reimbursement gap every year. In the association’s proposal, reforms to the CON law would begin after the effective date of the state implementing expansion and receiving HASP funds. If the HASP program ends, it could risk the financial viability of many of the state’s hospitals.  

The General Assembly is scheduled to reconvene Tuesday for what’s expected to be a three-day administrative session with no recorded floor votes. They are next scheduled to return to Raleigh in October.

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