bullworthThere’s a lot of press/action/movement on the Medicaid front for North Carolina and I’ve been trying to make sense of it all.

Here’s what a press release says:

“The N.C. Department of Health and Human Services on March 1, 2016, unveiled an innovative, multi-year draft plan for reforming North Carolina’s Medicaid program to drive better patient outcomes, higher quality patient care and more cost certainty. This comes after the September 2015 passage of historic Medicaid reform legislation, achieved under the leadership of Governor Pat McCrory and through the efforts of a supportive North Carolina General Assembly”.

The webpage found at this link, http://www.ncdhhs.gov/nc-medicaid-reform contains links to the following documents:

  • The Draft Medicaid Reform Waiver Application (Section 115 Demonstration)
  • A Medicaid Reform Report the Joint Legislative Oversight Committee on Medicaid and NC Health Choice
  • A presentation of the Draft Waiver and Report to the Joint Legislative Oversight Committee on Medicaid and NC Health Choice
  • Medicaid Talking Points
  • A Press Release titled: Medicaid Reform Plan Offers a North Carolina Solution.

“The public comment period for the draft Section 1115 waiver application opens March 7, 2016. Please visit the web page on March 7 to see how you can submit comments on the waiver application and other Medicaid Reform items”.

Please see this link below regarding the dates, times and locations for the Public Hearings on the 1115 Waiver.
Then someone pointed out that:
The waivers allow for expansion of services (payment for these services) outside of what Medicaid typically covers. Anything related to SUD begins on Page 16. of this document.

Here is a Fact Sheet put together by the NC Council of Community Programs.

They have an upcoming Spring Policy Forum June 20-21in Raleigh: Medicaid Transformation: A Closer Look. Here’s a link to that information.

Here’s what the NCSEG-North Carolina Stakeholders Engagement Group says; Medicaid Reform 101

Then this came out:
NCDHHS Leaders Propose a Medicaid Reform Plan

Last month, the leadership of the NC Department of Health and Human Services offered a three-year plan to the Joint Legislative Oversight Committee, which takes the State from a fee-for-service system to a value-based prepaid health plan. DHHS will submit the state’s waiver application to the Centers for Medicare and Medicaid Services (CMS) by June 1. It is expected to take at least 18 months to receive approval. Once approved, Medicaid reform will be implemented over the following 18 months. Medicaid beneficiaries will not see any change in services during the three-year interim. More information here.

It’s complicated.

I say:
Medicaid is a beast. Which is to say I have compassion for those charged with administering it. A complicated, lumbering beast. I do not (necessarily) mean bad or anything negative, but my MO is embracing what can be condensed into simple and Medicaid is not one of them. There are plenty of things; issues/topics/studies that do distill down, but Medicaid just ain’t one of them. So, I have empathy for all who must manage it, right on up to the Governor.

I have thoughts and ideas, starting with what has worked in other locations on the planet. Keep it simple means review and study so you do not have to reinvent another wheel. Of course there are numerous cultural concerns that make local creation essential. Health, real health is a deep and dear subject of study for me and that is related to Medicaid. There is a lot we could do to improve our overall health in America and it is similar to what we could do (and what is lacking) in treating substance use disorders. Which means I am apt and prone to look at it and it’s still hard to grasp solutions. That’s when art is useful, it can convey what linear thought cannot.
What I am reminded of and invite you to watch is an 18-year-old movie I saw again, the hilarious, truth-telling “Bulworth” starring Warren Beatty.

Have you seen it? If not, get on that Instant Netflix site tonight! It sums up this issue well. I remember when it came out I went opening weekend which meant a packed theater and as the movie unspooled I was bursting with laughter and over time I realized I was often the only one laughing in the whole room. Once over, as people got up to leave, I looked around and asked, “Wasn’t that great?” and noticed people, how-you-say kinda sliding away from me quietly with a, “Don’t talk to the strange man” look. I was floored. What happened to us America? The movie was (and still is) courageous, brilliant, hilarious, truthful, well-done, with a stellar cast. It co-stars Halle Berry, Oliver Platt, Don Cheadle, Paul Sorvino, Jack Warden, Amiri Baraka- (poet LeRoi Jones) and others, what more could you ask for!? The pivot point of the story is around health insurance companies, who, to quote the movie, “get 27 cents of every dollar they make”.

Aside from laying out the lies and truths of the health insurance game, it dissects race relations in America, poverty, and plenty more. Still managing my Spoiler Alert awareness, here’s a snippet from Roger Ebert’s review; “Bulworth is in trouble. He hates his job and his life, and has just lost millions in the market. So he puts out a contract on his own life and flies back to California thinking he has three days to live. His impending death fills him with a sense of freedom: At last he is free to say exactly what he thinks, and that’s what he does.”

Thus hilarity (and truth) ensue. The idea of impending death freeing us to tell the truth is a deeply appealing storyline to me.
Health insurance has also been on my mind due to reading reports of the NC Legislator’s desire to: “Shift management responsibility of Medicaid to a new agency called the Health Benefits Authority, and create a corporate-like structure to manage the Authority. Under this proposal, the new Authority would contract with three healthcare providers to provide services to LMEs/MCOs.” Put another way, it’s been said, “the program envisions management by regional Provider Led Entities (PLEs), statewide private managed care companies and regional LME/MCOs for MH/I-DD/SUD services.”
Then I stumbled upon “Bulworth”, after all these years, and here we are.
Illness/health and insurance, including the Affordable Care Act, have been at the top of the American zeitgeist for a while and for good reason. As stated, my desire is always to distill it down, make it simple whenever we can. Yet I must grant that Medicaid/Medicare are unwieldy beasts and concerns the Administration has about Medicaid are valid. Hence why we need to start with truths and grow a vision from there.
“Bulworth”, co-written, co-produced, directed by, and starring Warren Beatty, actually won an Oscar for Best Original Screenplay. But it never had a chance to really reach the public. Just to get a glimpse of how truth-telling this movie was, read what Wikipedia said:
Bulworth was made in complete stealth and released by 20th Century Fox only after protracted contractual wrangling, only for a brief period of time, and practically without any publicity. As Peter Swirski reports in his study of this film, “after 20th Century Fox backed out of producing Dick Tracy, Beatty used the leverage of a lawsuit to wangle unprecedented artistic freedom,” disclosing only the barest outline of the story and essentially duping Fox into bankrolling the project.
Epic multi-national media conglomerate that they are, Fox never would have bank-rolled this much honesty.
See this movie!

Next acronym (in the movie vein): INPSISB- “It’s not personal Sonny, it’s strictly business”. – Michael Corleone