The Wilkes County commissioners were told Tuesday night that the county’s transition to a Medicaid managed care system has been delayed to Feb. 1 due to North Carolina still not having a new budget.
“Without the approval of a budget, we can’t go through with it. So many things depend on” funding in the new state budget, said Wilkes Department of Social Services Director John Blevins.
Wilkes and 26 other counties were scheduled to switch from the current fee-for-service system to privatized managed care on Nov. 1. They were to be the first in the state to make this change with Medicaid, but now all 100 counties will transition on Feb. 1.
A little over two months into the new fiscal year, North Carolina still doesn’t have a new budget due to Gov. Roy Cooper, a Democrat, vetoing the budget bill because the Republican-controlled legislature won’t include funds to expand Medicaid eligibility.
Blevins gave the update on the transition to the new Medicaid program during his monthly report to the commissioners, who double as the board that oversees Wilkes DSS. He gives a report at the first of two commissioner meetings each month.
When N.C. Department of Health and Human Services Secretary Mandy Cohen announced the delay Tuesday morning, she said it will have minimal financial impact.
Blevins said a state representative is at Wilkes DSS to answer questions and help Medicaid clients enroll with one of four managed care companies—AmeriHealth Caritas, Blue Cross and Blue Shield of North Carolina, United Healthcare or WellCare. The state will pay an agreed-upon monthly rate per Medicaid recipient to the company the person is enrolled with in return for it handling all of the person’s medical needs.
He said that due to the delay, the period in which Medicaid recipients in Wilkes can choose which managed care company to enroll with was extended to Dec. 13.
Most of the 16,000 people in Wilkes on Medicaid must make the transition to managed care and the number signing up at Wilkes DSS varies from day to day, he added. They include low-income children and their mothers, as well as some seniors and disabled people who qualify for Medicaid.
Medicaid recipients statewide with complex physical and behavioral health needs will make the change in 2021.
Blevins noted that some counties on the same schedule as Wilkes don’t have enough providers signed up to participate in the managed care system.
In the fee-for-service system being replaced, the state manages and pays for every Medicaid client’s flu shots, hospital stays and other health care needs. A GOP-led legislature authorized the switch to privatized managed care in 2015, with a goal of having budget predictability and better health outcomes.
Medicaid is one of the largest programs run by the state, costing about $14 billion a year. North Carolina is also the largest state without a significant presence of commercially-managed care companies running Medicaid.