by Jordan Roberts
Director of Government Affairs, John Locke Foundation
Later today, Governor Cooper will address the state to delay Medicaid transformation again. Initially slated for a November 2019 rollout, then pushed back to February of 2020, moving the Medicaid population into private management, has now been delayed indefinitely.
How did we get here? Let’s go back several years. In 2015 the General Assembly passed a law that directed the Department of Health and Human Services to submit a federal waiver for transforming North Carolina’s Medicaid program into a managed care model. That’s when the work began.
Fast forward to 2019. This was the year that DHHS was going to begin the transfer of Medicaid patients into managed care organizations. Bid proposals were requested, and the selection process occurred to decide which managed care companies would provide care for our state’s Medicaid population. The first hiccup came when Governor Cooper vetoed the new state budget on June 28th, which included funding for transformation. Cooper said, “I am vetoing this budget because it prioritizes the wrong things,” by which he mainly meant it did not include Medicaid expansion.
After a long summer of acrimony between the legislature and the Governor produced no state budget, the legislature tried to fund the state government through mini-budgets that focused on specific areas. Cooper selectively chose which mini-budgets he would sign and veto. One that received his veto was HB 555, a stand-alone Medicaid transformation funding bill.
In light of today’s press conference, Cooper’s veto of HB 555 is the most contradictory of all. Given the urgency from Secretary Cohen and providers concerning funding for the transformation, why did Governor Cooper veto this funding bill? According to him, “Passing mini-funding bills that simply divvy up the vetoed Republican budget is a tactic to avoid a comprehensive budget that provides for health care and other important needs like education. Health care is an area where North Carolina needs us to do more, and to do it comprehensively.”
So how exactly does a veto of a separate bill just to fund Medicaid transformation provide for North Carolinians? According to a press release from DHHS released yesterday: “The suspension of work and the wind-down process will begin tomorrow.” Vetoing this funding bill doesn’t appear to coincide with Governor Cooper’s desire to provide health care for North Carolinians.
It is interesting to note too that DHHS blames the legislature for the delay. “The North Carolina Department of Health and Human Services today announced that because the NC General Assembly did not take needed action, managed care implementation and open enrollment for NC Medicaid must be suspended. The General Assembly adjourned last week without providing required new spending and program authority for the transition to managed care. Managed care will not go live on Feb. 1, 2020,” DHHS said in a press release.
Cooper has vetoed Medicaid transformation twice. Once when he vetoed the original conference budget passed by the legislature and once when he vetoed the mini-budget. Decision-makers, including Governor Cooper, have known about the proposed rollout dates for months. The delay of Medicaid transformation falls squarely at the feet of Governor Cooper.