Wilmington NC Counseling Blog

Let the Medicaid Consolidation Fun in North Carolina Begin!

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Hot off the internet presses!

Looks like CoastalCare and East Carolina Behavioral Health are merging. They are charged with merging by July 1, 2015.

Here is part of the press release with important words bolded:

Maintaining a local presence and taking the least disruptive approach for consumers, families, providers, the community, and employees of the current agencies is paramount for the new organization. With a total population of 1,259,757—and an estimated 165,000 of those people eligible for Medicaid–the combined agency would have an approximate budget of $400 million annually.

Norman stated, “It’s important to remain visible and ensure our community understands available resources and where to call for access to care.”

The new entity will maintain about 400 employees and keep current office locations across the 24-county area. The region served will include Beaufort, Bertie, Brunswick, Camden, Carteret, Chowan, Craven, Currituck, Dare, Gates, Hertford, Hyde, Jones, Martin, New Hanover, Northampton, Onslow, Pamlico, Pasquotank, Pender, Perquimans, Pitt, Tyrrell, and Washington counties

ECBH CEO, Leza Wainwright said the consolidation would increase the efficiency of the current system, and make it easier to navigate for consumers and providers alike.

Under current operations, providers who serve several different counties could be working with CoastalCare and ECBH, which means using two different processes for service authorizations and claims. Some people receiving services may need to travel to another county to see a certain provider in order for their regional network to match their Medicaid assignment,” Wainwright explains. “Consolidating will streamline these issues and will assist in making services easier to provide and receive.”

Questions for Us as Providers

I have a couple questions that i assume will be answered over time.

  • They say,”under current operations…there are two different processes for service authorization,” that means that they are going to revert to one. This means that there is a 50% chance of having to learn yet another system for practitioners in New Hanover County. Question: Will we have to learn yet another system?
  • For those of us who are independent providers will we have to go through the credentialing process again or will we be rolled in to the new giant HMO?
  • Right now the provider panel is closed for CoastalCare, does this mean it will open again for the giant HMO?
  • They are going to trim staff down to 400, does this mean layoffs for CoastalCare staff and if so, is the cost savings passed on to expand the pool of money for services or do administrator salaries get bigger, or does the money go back to the offices of the current voted regulators in Raleigh?

I could go on and on here but it sure would be nice if they would pick one system and stick with it.

Last thing I will say may not be popular but I am saying it anyway.  I would LOVE to see a cost analysis of how putting an HMO between providers and medicaid is actually saving any money for the NC state government considering the amount of overhead for the HMO’s including massive buildings and administrator salaries.

Have fun doing real work of seeing real people.


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