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Medicaid reform, redux

healthcare_piggybank.jpgYes, it's June already, and the NCGA still doesn't know what they're doing about Medicaid reform. You might remember that they tried, and failed, to come to an agreement last year on the very same topic. 

This morning, we got a glimpse of the House's proposal. It isn't very different from what they proposed last year.

The House proposal would deliver Medicaid services through organizations created in-state, such as hospitals and physician groups that choose to manage a group of no less than 30,000 patients at a time. Those organizations, “provider-led entities”, or PLE's, would be given a set amount to cover services for all of those patients, putting the financial risk on these PLEs to meet patient care and quality goals without going over budget. (There would also be rewards and penalties for PLEs that meet or fail to meet performance and quality goals.) All of this would be overseen by the Department of Health and Human Services which would be authorized to “take all actions necessary to implement the Medicaid transformation” and be given a 5-year timeline to complete the process.

This is all well and good - it's not a bad proposal. The problem is that the Senate has already said that they will propose a radically different plan, along the lines of what they offered last year. That sets us up for yet another showdown between the House and Senate on dueling Medicaid proposals.

With the same ideas from the House and Senate that we had last year, there isn't much hope that the outcome will differ much, either.