NC Senate plan to overhaul state Medicaid program draws fire from doctors and hospitals

The North Carolina plan was presented by state senators during a Wednesday meeting of the Senate Rules and Operations Committee. Also, Arkansas Medicaid officials have reportedly said they are restricting access to an expensive cystic fibrosis drug because data don't support its use as a first-line option -- highlighting a wave of drug-coverage questions playing out across the country.

North Carolina Health News: Newest Medicaid Reform Plan Gets Tepid Reception
Dr. Conrad Flick's primary care office in Raleigh is not the kind of place where you'll see a lot of ties. Instead, the eight doctors and nurse practitioners at Family Medical Associates of Raleigh are more likely to wear polo shirts or scrubs and take the time to sit and listen to patients. But Flick's easy-going demeanor drops away quickly when he starts talking about the Senate's latest plan to reform North Carolina's Medicaid program. His voice becomes frustrated and angry. The system Flick refers to is one presented by state senators during a meeting of the Senate Rules and Operations Committee Wednesday morning. In the plan, senators call for moving the state's Medicaid program to a "fully capitated" managed care system whereby doctors and hospitals are given a set amount of money to care for patients, no matter how complicated, and are compelled to live within that budget (Hoban, 7/17).

Raleigh News & Observer: NC Senate's Proposal For Medicaid Overhaul Draws Criticism
A new Senate plan to overhaul the state's Medicaid program drew immediate fire from doctors and hospitals who do not like that the proposal would open the state to commercial managed care for people using the government insurance. The legislature is trying to change Medicaid so the state knows each year about how much the program will cost (Bonner, 7/16).

Here's more on the Arkansas story -

The Wall Street Journal: Costly Vertex Drug Is Denied, And Medicaid Patients Sue
Arkansas officials declined to comment on specific allegations but said they are mainly restricting access because existing data don't support the drug's use as a first option. Cost also appears to be a factor: Emails obtained by the patients' attorneys show officials discussing Kalydeco's cost, and their worries about the expense of future cystic fibrosis drugs. The legal flap is the latest example of the pressure expensive new drugs are putting on cash-strapped government insurance programs (Walker, 7/16).

In other state Medicaid news, Denti-Cal's reimbursement rates in California are affecting access and Florida's Home and Community-Based Services Medicaid waiver.

The California Health Report: Denti-Cal Patients Feel The Pain As Rates Shrink
A few years ago, Kathleen Hamilton became a foster mom to 13 and 14 year old boys, who also happened to be her nephews. Both needed extensive dental work, and the services were to be covered by the state's Medi-Cal program. But year after year, Hamilton ran into a snag. "It was difficult to find a dentist who would take new Medi-Cal patients," she recalls, "and every time I would go to make the next appointment, [the previous] dentist wouldn't see them. I hopscotched all over East County San Diego, driving almost to Mexico," she says (Johnson, 7/16).

Health News Florida: 1,200 With Critical Needs Off Waiting List
About 1,200 Floridians with critical needs will be getting enrollment letters from the Agency for Persons with Disabilities in the next two weeks. Those with critical needs on the agency's waiting list as of July 1 will be offered enrollment in the Home and Community-Based Services Medicaid waiver. Overall, there are 21,141 on the waiting list as of June 1, according to Melanie Etters, the agency's communications director (Menzel, 7/16).