RALEIGH — Due to a lack of funds resulting from the state budget stalemate between Democratic Gov. Roy Cooper and the Republican-controlled N.C. General Assembly, the state’s managed care implementation and open enrollment for N.C. Medicaid has been suspended indefinitely, the N.C. Department of Health and Human Services announced Nov. 19.
“With managed care suspended, N.C. Medicaid will continue to operate under the current fee-for-service model administered by the department,” the N.C. DHHS stated on Nov. 19. “Nothing will change for Medicaid beneficiaries; they will get health services as they do today. Behavioral health services will continue to be provided by Local Management Entities/Managed Care Organizations. All health providers enrolled in Medicaid are still part of the program and will continue to bill the state through NCTracks.”
The long-time planned switch to transform N.C. Medicaid and N.C. Health Choice from fee-for-service to managed care was directed by NCGA legislation in 2015. The department was on track to go live on Feb. 1, 2020, and was dependent on new funding and program authority in the 2019-20 biennium budget. The N.C. DHHS stated that the department would have been “vulnerable to an unprecedented cut that would have had a crippling effect” on the roll-out.
The budget, passed by the NCGA in late June, was vetoed by Cooper shortly after. Without a 60 percent Republican supermajority to override the veto, the budget has been in the N.C. Senate since Sept. 12 without having been brought up for a vote. On Sept. 11, the N.C. House passed a veto override with most Democratic members absent.
Subsequent “mini budget” bills on N.C. Medicaid have been vetoed by Cooper, who has been pushing for Medicaid expansion in the biennium budget.
Both sides were quick to blame the other for the delay of the implementation.
“(N.C.) Republican legislators were irresponsible to end the session without moving health care forward,” Cooper said in a Nov. 19 statement. “By choosing gridlock instead of negotiating a compromise, they delayed Medicaid transformation and broke their promise to vote on expansion, leaving 500,000 North Carolinians without affordable, quality health care.”
“This is another crisis of Governor Cooper’s own making,” said Sen. Joyce Krawiec (R-Kernersville) in a Nov. 19 statement. “The (N.C.) General Assembly passed a clean stand-alone bill to provide the transformation funding Governor Cooper’s own DHHS secretary said she needs to do her job. His veto will force insurers to lay off thousands of people they’ve already hired as part of the years-long plan to transform Medicaid.”
The Medicaid Managed Care Call Center will stay open through Dec. 13, 2019, to answer questions but will no longer enroll beneficiaries in a health plan, the N.C. DHHS stated. Beneficiaries can continue to contact the Medicaid Contact Center at (888) 245-0179. Notices will be sent to beneficiaries informing them to continue accessing health services as they do now, rather than through new health plans.