Over 25 family physicians converged on the Legislature last Wednesday (July 13) to fight for your patients, your practices, and your profession. What looked like it could be a slow week at the Legislature turned into the exact right time for the NCAFP to advocate for you as key bills on how Medicaid Reform will be implemented landed on the House and Senate calendars. Most importantly, a draft of a bill that would license and regulate Medicaid managed care plans included some last-minute surprises. At the 11th hour, some senators sought to cap the required Medical Loss Ratio (the MLR) managed care plans would have to meet at 85 percent, as opposed to a minimum of 88 percent proposed by the Department of Health and Human Services. The MLR is the portion of every dollar that the plans must spend on health care. But the NCAFP and others in the healthcare community fought back, keeping over $400 million in state and federal dollars to provide healthcare as opposed to added administrative fees and profits for the managed care companies. A senator also proposed stripping out all funding for medical homes, which would have meant the loss of any care management or medical home fees that practices would receive in the new system. The NCAFP, NC Pediatric Society, NC Medical Society and others fought back against the changes and prevailed on the first two points. A proposal to prohibit certain accountability measures for managed care plans through the use of withholds by the Department did move forward but with a shortened timeframe (only an 18-month prohibition).
The Legislature also considered a bill that would allow integration of some behavioral health care in primary care for Medicaid recipients. Individuals with mild to moderate behavioral health issues will be covered by standard Medicaid plans, fully integrating physical and behavioral health. Specialty/tailored plans, initially run by the current LME/MCOs, will manage more severe behavioral health issues but will also be responsible for the entire healthcare spend for that small portion of the population.
The timing of the NCAFP’s White Coat Wednesday couldn’t have been better with your entire Executive Committee, several Duke Family Medicine residents, a resident from Cabarrus Family Medicine, two medical students and several other practicing family physicians lobbying senators and representatives throughout the day. Thanks to the NC Medical Society’s Sue Anne Forrest for hosting a breakfast briefing that morning, and to Chip Baggett, also of the Medical Society, for leading over a year-long effort to negotiate provider protections in the licensure bill.