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AARP Outlines Consumer-Centered Medicaid Reform

As North Carolina lawmakers look at changes to the state's Medicaid program, AARP's Mary Bethel provided the following testimony to the Medicaid Reform Advisory Group

Medicaid Forums

"In addressing Medicaid reform, AARP North Carolina believes that we need to build on what works.  North Carolina has a model program in Community Care of North Carolina (CCNC).  This home grown program has excellent provider buy-in, has saved the state billions of dollars in health care costs, and has also ensured access to care for thousands of our state’s residents.

As has been widely publicized, a 2011 Milliman study showed that approximately $1 billion was saved by the Medicaid program in FY 07 through FY 10 due to efforts including the work of the CCNC.  As late as yesterday, the Fiscal Research Division staff of the General Assembly told the HHS Joint Oversight Committee that due to aggressive and effective measures to control increased Medicaid spending, our state’s spending on Medicaid claims has declined overall by 11.6% on a per member per month basis since 2008.  During this time, per member per month spending in the U.S. as a whole has increased overall by 6% over that same period.

As we move forward in looking at reform of our Medicaid program, we ask that you don’t throw the baby out with the bath water.  We need to build on the CCNC program that has a proven infrastructure in place and tweak it to make it better to achieve the reform objectives.

CCNC already has many programs in place to address care of patients with chronic care conditions and has the means to better reach and serve the dual eligible population.  CCNC is also in a good position to better integrate behavioral and physical health for Medicaid recipients as well as to pay an even bigger role in coordinating care of all Medicaid recipients.

Being an old war horse working in the field of aging and health for a long time, I have had the opportunity to meet and talk with many people from other states about health care delivery.  Without exception, I hear over and over again from folks from all over the country that CCNC is the model for coordinated care and the management of cost.

Based on a proven track record and a stellar reputation, we believe that CCNC should be the cornerstone of any reform efforts the state undertakes.

Consumer-Centered Medicaid Reform

Because we are a consumer advocacy organization, I want to spend the remainder of my time offering comments on principles that we trust will be considered in Medicaid reform to ensure it is consumer focused.  For the most part, these are principles that have been advocated for in numerous other states, including Alabama, that have addressed Medicaid reform.

  1. Consumer engagement is critical.  Medicaid is more likely to meet consumer needs if consumers and advocates are involved at all levels of planning and implementation.  As a consumer organization, we offer our assistance in this effort.
  2. Better health is the bottom line.  Meaningful reform must address the central role that poor health outcomes play in health care costs.  Ensuring access to and utilization of preventive and primary care will reduce costs in the long run.
  3. Successful Medicaid reform treats the whole person.   It is imperative to offer comprehensive services to improve health outcomes.  This includes ensuring that aged, blind, and disabled adults continue to have access to the optional services that are now part of our state’s Medicaid benefit package.  If services such as physical therapy and dental care are not offered on the front end, history has shown that there is often a bigger cost on the back due to increased admissions to acute care facilities and long-term care facilities.
  4. Special needs require special accommodations.  Care that is well suited to the average patient may not be adequate for persons with complex health needs such as children with special needs, people with disabilities and the frail elderly.  Often these individuals rely on particular care providers who are capable of delivering a full range of appropriate services.
  5. Expanding home and community-based services can improve outcomes and save money.  Care for persons who depend on long-term services and supports should use proven care models that are based on consumer choice and self-direction.  We need to take steps to further strengthen our home and community based care programs, including taking advantage of opportunities made available through the new health care law to expand services.  In addition, we need to look at ways to support the family caregivers of those receiving services so they can continue to be an integral part of the care delivery system.  By the way, as you may know, family caregivers provide 80% of the care to those in need of assistance.
  6. Medicaid reform requires a robust provider network.  It is imperative that patients have a choice of providers and they do not have to wait long or travel long distances for necessary care.
  7. Means to ensure quality and accountability must be in place.  A few of the recommendations we offer in this regard are as follows:  We advocate for the creation of an independent ombudsman to maintain a consumer hotline, to address consumer complaints, to identify problems and propose solutions to the state, and to issue a report annually which in made public on the type and number of complaints.  There also needs to be a consumer friendly appeals process in place.  Last but not least, payment rates need to adequately reflect the cost of providing comprehensive care to the population served, which needs to be higher for people with complex health need.
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