Medicaid Is Kinda Boring. Here’s the Least You Need to Know

Doctor talking with a patient during an exam.Real talk: news stories about Medicaid make most readers’ eyes glaze over. In fact, I’m surprised you even clicked on this one at all. The truth is it’s hard to talk about a government-managed health system without getting a bit technical, or as we like to say in the news business, wonky.

Wonky means you are so deep inside a subject that you can’t explain it to outsiders. And I think for many of us who write about North Carolina’s Medicaid, the word “wonky: isn’t just an adverb; it’s a state of being. It can be hard to describe a $13 billion program that serves 1.7 million state residents. You can forgive reporters for being so lost in the magnitude of the decisions and finances that they forget how to relate this behemoth to the average reader.

So here’s what I want to share with you about North Carolina’s Medicaid system.

  • There’s some news. Aldona Wos is head of our state’s Department of Health and Human Services. Wos recently shared that a legislature committee decided to create an independent body to oversee Medicaid, despite earlier opposition from lawmakers about creating such an entity. This is mixed news, since basically no one knows how the independent governing body will function, nor who will serve on it.
  • Its future is uncertain. Members of the General Assembly and other state leaders are frustrated that Medicaid costs frequently seem to overrun estimates. In October, Wos announced the program had kept under budget for the first time in years, with a savings of $64 million less than what they budgeted to spend. Despite this good news, many want to make big changes to Medicaid, changing the fundamental way it works. The proposals for change are complicated, but basically amount to letting outside firms compete to manage the system, with bonuses for staying under budget. Good news for the bottom line  — but potentially bad news for patients who want to be viewed as more than a cost center.
  • It could be expanded. You’ve definitely heard the words “Medicaid expansion,” but what does that mean? The federal government has offered states money to expand health coverage to more impoverished residents. In our state this expansion would give more than 200,000 people high quality health care. Most of those who would benefit are women and children. Our state government turned down this money, saying they were afraid the government would end its support once a new President was elected to office. Recently, Governor McCrory has softened a bit on the subject of taking the federal funds. He’s said once NC’s Medicaid is “fixed” he’ll consider expanding it to more people.

I had an editor who said our writing was too wonky if it contained any of the following words: funds, policy, fiduciary. Reading over my bullet points I hit all but “fiduciary.” Still, I hope this rundown of NC’s Medicaid program was a little lighter reading, despite that.

Do you have any questions about Medicaid? Tweet me at @dillettantrum and I’ll do my best to answer them or find someone who can!




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