Question

Discuss the current status of Medicaid Managed Care in Both Carolina. What are the benefits and challenges faced by this State and why? How is the state capitalizing on the benefits and how are they mitigating or responding to challenges? If your state does not participate, choose a state to discuss that does. Please include references

Answer 1

The current status of Medicaid Managed Care in NC is without a full state budget plan. Medicaid is a health insurance program for low-income people, children, pregnant ladies, and people with disabilities.

The plan was to move from fee for service to managed care this year, under which state would pay a fee to the managed care plan, which can then be paid in turn to doctors or service providers. But the plan was stalled due to budget issues.

Thus, currently, NC would not change Medicaid to Managed Care.

Benefits include 90% of the annual cost of Medicaid expansion taken care of by the federal government. Also, there are about 2.2 million residents enrolled in the Medicaid program in NC. Plus, under the present program, the state pays the doctor directly for the services given.

And when it comes to challenges, it is one regarding the budget allocation. If it expands Medicaid under the Affordable Care Act, then it would include more than 389,000 NC residents. The threat of federal paying less towards Medicaid is also a challenge that is holding the authorities away from managed care. An earlier instance of the federal government changing its match rate for CHIP( Children’s Health Insurance Program) was reduced by 11.5%

The state is providing uninterrupted services under Medicaid as previously. The challenge worsened in the COVID-19 attack.

Recently, they passed a Medicaid Transformation bill to continue the transition from fee for service plan. A fund is set up for this transformation project under Senate Bill 808 to mitigate the challenges.

Further contracted with managed care organisations like Blue Cross, UnitedHealthcare of North Carolina, etc is made to administer the transformation.

Thus, they are moving aggressively towards the new plan which has been thwarted by the pandemic.

Getting brilliant on Medicaid

Medicaid is the greatest program run by the state, however that doesn't mean it's straightforward. Here are some speedy definitions to assist you with processing exactly what's happening.

Medicaid: This is a government wellbeing net program intended to give social insurance to weak occupants. In South Carolina, it serves 2.1 million low-pay seniors, individuals with incapacities, kids and their families. It's supported with $14 billion in bureaucratic and state dollars, with the government paying $2 for each $1 the state contributes.

Medicaid change: This is the move in progress to switch Soouth Carolina's Medicaid program to oversaw care, where the state will pay five oversaw care organizations $30 billion throughout the following five years to deal with the medicinal services needs of 1.6 million Medicaid patients. A half-million other Medicaid beneficiaries with complex conduct wellbeing needs will move to extraordinary, custom fitted oversaw care designs later on.

Medicaid extension: This is a mark bit of the Obama Administration's Affordable Care Act, where states can choose for utilize government assets to extend Medicaid inclusion to low-salary grown-ups. South Carolina is one of 14 states, to a great extent in the Southeast, to dismiss Medicaid development up until this point. N.C. Gov. Roy Cooper, a Democrat, has made Medicaid development an absolute necessity have in spending arrangements, while Republican state officials have so far opposed calls for extension.