NCMS EVP/CEO Responds to Senate Vote on Medicaid Reform

July 24, 2014

Today the North Carolina Senate tentatively voted 28 to 17 to use outside managed care corporations as part of their Medicaid reform plan. The North Carolina Medical Society (NCMS) has adamantly opposed this type of solution and has worked for more than a year in collaboration with legislators, the Department of Health and Human Services and the Governor to develop a homegrown reform plan that addresses the needs of patients as well as the budget predictability sought by the General Assembly. The NC House, the Governor and other health care stakeholders support this alternative to managed care.

Immediately after the Senate vote today NCMS sent the following statement from NCMS EVP/CEO Robert W. Seligson to media statewide:

“Today the Senate had a clear choice between the health of our state’s most vulnerable citizens and the health of Wall Street corporations, and they chose the corporations. Despite strong alternative proposals from the North Carolina House, Governor McCrory and the health care community on the best way to improve patient care and quality and provide budget predictability, Senators voted against this consensus. Outside managed care companies have a dismal track record of success. The Medical Society would like to recognize and appreciates the bipartisan support for the consensus plan of the health care community, the House and the Governor on the Senate floor today. It appears that the 28 senators who voted for managed care are not aware or don’t care about the negative history of managed care and are welcoming it to North Carolina.”

For instance,

  • Kentucky moved 550,000 of its Medicaid patients to three national managed care corporations in 2011. Since then, a 2012 evaluation by the Urban Institute found that patients faced delays in getting care, and there was an adversarial relationship between the managed care plans and the medical community. State legislators continue to be flooded with complaints and passed a bill to set up an appeals process at the Department of Insurance to mediate disputes between the medical community and the plans. One of the managed care plans pulled out of the state last year, suing the state saying it lost money and forcing 125,000 patients into the other two plans.
  • In Illinois, a federal judge awarded over $334 million in a fraud lawsuit against the Medicaid HMO Amerigroup Illinois and its parent company, Amerigroup Corporation, for systematic and extensive fraud for discriminating against pregnant women and those with expensive medical conditions.
  • In Georgia, their Medicaid program was fined $3.7 million for consistently refusing to pay for authorized care.
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