Physician Perspective on Medicaid Expansion

The Right Foundation for Expansion

The NCMS has been working closely with legislators and the North Carolina Department of Health and Human Services (DHHS) for the past 4 years to ensure that the state's Medicaid program can support and sustain expansion. Expanding the Medicaid rolls by 500,000 additional beneficiaries is important [1], but we must be certain the system is prepared to absorb such a large number of enrollees at one time. The system must be able to seamlessly take in and finance those newly eligible for Medicaid assistance now and in the future.

When the General Assembly began looking at how to improve the Medicaid program 4 years ago, we told House and Senate leadership that we supported expansion of Medicaid and that we appreciated the state's need to better predict and control costs in the Medicaid program. Although the federal government offered to pay the full cost of initial Medicaid expansion, the state's long-term obligations to maintain the program were a concern. We encouraged legislative leaders to explore all options to ensure that sustainable financing for Medicaid is possible.

Better management systems have been established since those early discussions, and efficiency has improved in the Medicaid program [2]. Costs have come in below budget projections. This good news should provide significant assurance to legislative leaders that the current Medicaid program is delivering value to taxpayers and high-quality care to its enrollees.

Reform and Strengthen the System

The Medicaid reform legislation signed into law last fall has provided an initial framework from which to build a new and, hopefully, more financially predictable and sustainable program that will provide high-quality care for our state's most vulnerable individuals. As the details are hammered out in the coming months, we are optimistic that the reforms will offer lawmakers more assurance that North Carolina's Medicaid program is ready to expand to provide quality care to greater numbers of those in need of assistance.

As the organization representing those with the clinical expertise to understand what quality care encompasses, the NCMS has repeatedly communicated with lawmakers and described the basic tenets we believe are necessary to achieve a Medicaid program that promotes efficiency and high-quality care.

The first tenet of such a program is that it should be led by physicians. Toward this end, the NCMS has helped to make certain that physicians retain a majority on the governing board of provider-led entities (PLEs). We hope that this will help the Medicaid system remain focused on patient outcomes and quality and will enable the move to a value-driven structure.

Second, the new Medicaid system should have an open, transparent, and affordable health information exchange. The NCMS is therefore pushing for a health information exchange that all practices and physicians can access at minimal cost.

The third tenet of a successful and sustainable Medicaid program is patient choice in selecting a health plan. We support providing patients with a choice in their health plan, focused around the primary care provider relationship with the help of a navigator. In the auto-assignment process for those who do not actively choose a plan, DHHS must ensure a patient's existing primary care provider relationship is preserved.

Finally, the new Medicaid system should engage social services to assist patients. This could include partnering with public health authorities, faith communities, and other community organizations to help with patient transportation issues, medication monitoring, and identification and development of programs in nonclinical settings to address issues like alcohol misuse, tobacco cessation, obesity screening, and nutrition counseling. The NCMS urges DHHS to emphasize social supports as a mechanism to assist physicians and other clinicians in keeping their patients healthy. Addressing social determinants of health will also be critical in transforming the health care system as desired.

North Carolina is faced with a tall order: We must create a Medicaid program that truly serves all those who need it, and this program must be financially predictable, sustainable, efficient, and clinically sound. The state has made good progress toward this goal by streamlining and refining its current management of the program. The Medicaid reforms adopted last fall also offer the opportunity to design a Medicaid system that furthers these goals. We are working closely with state lawmakers to make an improved—and expanded—Medicaid program a reality for all those North Carolinians who need assistance.