What Medicaid Reform will look like

Published March 8, 2016

By Katherine Restrepo, John Locke Foundation, published in The Locker Room, March 8, 2016.

North Carolina’s Medicaid reform is changing the way doctors get paid. The state is shifting away from reimbursing providers under a fee-for-service system to one that pays them a lump sum to provide health care services for Medicaid patients. The idea is to inject more budget predictability and improve the the program’s value.

Right now, the North Carolina Department of Health and Human Services (DHHS) and other key stakeholders are figuring out the logistics. The map below outlines the six proposed regions in which both hospital systems and managed care companies will be responsible for delivering care to Medicaid patients within a defined budget. Each region also has an equal distribution of patients.

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For those really interested in the way North Carolina envisions its Medicaid reform, have at the 60-plus page federal waiver application here.