Federal health regulators made another pitch Monday about the benefits of expanding Medicaid coverage in North Carolina and 18 other states, this time focusing on behavioral health issues.
Legislators have debated for more than three years about whether to expand Medicaid coverage to an additional 500,000 North Carolinians. Medicaid covers about 1.9 million North Carolina residents and is a $14 billion-a-year program.
The Affordable Care Act provides resources for states to extend coverage to all non-elderly adults with income below 133 percent of the federal poverty level, currently $32,253 for a family of four and $18,000 for an individual.
“Medicaid expansion under the ACA can greatly improve the quality of life for state residents by improving access to treatment for behavioral health needs,” Centers for Medicare and Medicaid Services officials said in a 17-page report. “Among this population, there is great need for treatment, as about 30 percent (144,000) have either a mental illness, substance use disorder or both.”
Gov. Pat McCrory has said that he opposes expansion unless he can secure federal waiver exceptions for what he has called “a North Carolina plan, and not a Washington plan.” Key Republican legislative leaders have said expanding the program is a non-starter.
State health officials are preparing to submit a request for CMS to approve Medicaid waivers by June 1 that would allow North Carolina to operate with three groups, likely insurers, serving as statewide managed-care organizations, or MCOs. Officials with the Department of Health and Human Services have requested from legislators the flexibility to have up to 12 provider-led entities serving at the regional level, up from 10 set in the state law passed in September.
In the reform plan, behavioral health MCOs would work as subcontractors for the insurers and provider-led entities.
CMS officials acknowledge that they haven’t looked specifically at how negotiations would go with McCrory and state health officials.
McCrory also has said he will not consider expansion until the program “is fixed.” On March 1, officials with the DHHS said the program is on track for a third consecutive surplus, based primarily on less demand than projected and lower prescription drug costs.
The projection is that it could take three to five years to gain federal approval and implement the strategy.
There is an expectation that the Obama administration could attempt to tie the Medicaid waivers to expanding the state program — a tactic some analysts say is not likely to work.
Vikki Wachino, CMS’ director for the Center for Medicaid and CHIP services, declined to comment when asked if such a link is being discussed.
Rep. Donny Lambeth, R-Forsyth, said he does not expect Medicaid expansion to be debated during the short session that begins April 25. Lambeth was the key legislative writer of the Medicaid reform law.
“This is a major policy issue and better for the long session,” Lambeth said. “We have been told this will be a focused short session with limited controversial agenda items.
“I am working on some options and possible solutions.”
Donald Bryson, state director for right-leaning Americans for Prosperity N.C., said Wednesday that the state has had the Medicaid surplus "thanks to common-sense conservative reforms and a steadfast refusal to expand the entitlement program" that contributed to "unpredictable cost coverages."
The goal with capitated care, which uses a set amount of money to pay for each enrolled person compared to fee-for-service care, is to reduce costs while improving patient care.
CMS officials acknowledged the cost-reduction emphasis of opponents by saying Medicaid expansion would reduce state and local governments’ costs in serving those with behavioral health issues.
“Not only will more of these individuals be likely to receive treatment, but this coverage expansion may reduce other medical costs, increase employment productivity, lower overall rates of depression ... and indirectly reduce criminal justice costs,” CMS said.
CMS said that one study of low-income adults with serious mental illness are 30 percent more likely to receive treatment if they have Medicaid coverage.
“This will be especially important to states as they work to address opioid use disorder and serious mental illness,” CMS said.
State health Secretary Rick Brajer has said that “everybody acknowledges there will be a discussion about whether expansion is right for N.C., but legislators represent N.C. and they will decide what will go forward.”
Mark Hall, a nationally recognized health care law expert at Wake Forest, released a 12-page brief Jan. 25 that weighs the pros and cons of expanding the state Medicaid program. Hall and research assistant Edwin Shoaf came down in favor of expansion.
“There is no real disagreement that, without Medicaid, low-income people fail to receive the behavioral health care they need, so Medicaid expansion clearly would improve mental health,” Hall said.
Still, Hall said, the CMS study “is unlikely to change the minds of people who are opposed to expanding Medicaid.”
email@example.com (336) 727-7376 @rcraverWSJ