North Carolina Wants To Shift Medicaid Program To A Managed-Care Model
The Federal government hasn't approved the transition, but the state expects the waiver to get a green light. Medicaid news comes out of Texas, as well.
North Carolina On The Hunt For Medicaid Managed-Care Organizations
North Carolina on Thursday began the process of raking in proposals for organizations hoping to participate in the state's new Medicaid managed-care program starting in 2019. The state has asked the federal government for permission to transition its $14 billion Medicaid program from fee-for-service to a managed-care model where it will pay organizations a per-member per-month amount to provide services to more than 2 million beneficiaries. The CMS has not yet approved the state's waiver application, but state officials expect to receive approval soon. (Livingston, 8/9)
CMS Rules Against Texas In Medicaid Payment Case
A CMS appeals board this week quietly ruled against Texas on a controversial Medicaid funding provision, raising questions about billions of Medicaid dollars paid out to the state. Under a Medicaid waiver, Texas between 2011 and 2016 leaned on private hospitals to finance Medicaid uncompensated care payments on behalf of the state. Based on a sample — two country hospital districts in the fourth quarter of 2015 — the appeals board determined that the state was wrongly financing the program. (Diamond, 8/9)