Medicaid transition plan draws limited sign-up participation | Govt-and-politics
Five years’ worth of often-controversial public health and legislative debate culminated in July 2020 when Democratic Gov. Roy Cooper signed Republican-sponsored legislation that provided pivotal start-up funds.
Dave Richard, the state’s deputy secretary for Medicaid, said the transformation is designed to insure that Medicaid recipients will continue to see the same medical provider if available through the PHP, and that providers will get paid.
“There’s nothing more fundamental to getting this right than to having that kind of commitment,” Richard told legislators. “This is Job One when we go live.
“If we implement this transformation this way, we will be the best in the country.”
Background
Managed care is a system under which people agree to see only certain doctors or go to certain hospitals, as in a health maintenance organization, or HMO, or a preferred provider organization, or PPO, health-insurance plan.
Under the current Medicaid system, providers are paid on a fee-for-service model administered by DHHS.
By contrast, the PHPs will pay health-care providers a set amount per month for each patient’s costs. DHHS will reimburse the PHPs.
There will be a limited number of special-needs individuals who will remain with fee-for-service providers.
