Lack of medical services puts Medicaid in critical condition

Carteret County's Department of Social Services (DSS), along with other agencies across the state, are preparing as best as they can, for what they expect will be a flood of Medicaid applicants beginning on Dec. 1. Unfortunately, while these county agencies will be opening the door to thousands of individuals and families who will be seeking medical assistance, there is serious doubt about the availability of the medical services.

Cheryl Burke notes in today's issue of the News-Times that the county's DSS staff is concerned that new Medicaid recipients seeking dental care will be hard pressed to find a dentist since there is only one in the county currently accepting Medicaid patients.

According to county's DSS figures, Carteret County has over 14,000 citizens currently receiving Medicaid assistance, with the total expected to expand by another 4,000 applicants. For the state overall, the expectations are that over 600,000 new applicants will be added to the Medicaid program.

The expansion, which has been a target for Governor Roy Cooper since his inauguration, has been debated by the legislature for over 13 years. Earlier this year, the legislature fearful of a gubernatorial veto of the upcoming biennial budget, included the expansion in the budget, ostensibly to prevent Cooper's veto.

In describing his begrudging support for the expansion, Sen. Majority leader Phil Berger noted three reasons for his willingness to reverse his years of opposition.

He noted that the economic impact on the state will be negligible since 90% of the expense is being paid by the federal government and that the remaining 10% of the cost will be paid by new assessments to hospitals. He also pointed to new reforms, such as removals of Certificate of Need restrictions on medical services, that will make access for both Medicaid as well as private paying patients easier and ostensibly, more affordable.

"Lastly," Berger said, "the majority of adults that would be covered under expansion are already part of the work. These are individuals who make too much to qualify for traditional Medicaid, do not qualify for (Affordable Care Act) subsidies, and can't afford to buy health insurance on their own because of the perverted, and I believe intentional, design of the ACA. These working North Carolina citizens are caught between a rock and a hard place."

These intentions are all good, but there is a missing ingredient that the legislature failed to consider when it passed the legislation. Are there adequate facilities and providers available to meet the anticipated demand?

Considering Carteret County's availability of only one dentist willing to take Medicaid patients, which is probably a minor problem in comparison to other counties where the number of new applicants will be much higher proportionally, the answer is most likely NO.

Director of the county's Consolidated Human Services Board, Dr. Randall Williams, expressed this concern during a recent board meeting asking, "Why expand it (Medicaid) if there aren't enough providers?"

Jaymie Baxley, writing for NC Health News noted, "If not for Medicaid, the majority of residents in Robeson County wouldn't have health insurance. Fifty-four percent of this rural community are beneficiaries of the government-funded program," he writes, "the eighth highest number recorded of the state's 100 counties." And more will be added after Dec. 1.

The legislature, in its rush to expand Medicaid, failed to take into consideration the insufficient number of providers and the lack of incentive to become a provider, particularly in rural, low wealth communities where most of the Medicaid beneficiaries will be added.

Doctors are already facing declining compensation for their work because of pressure from third party payers, the behemoth health insurance companies that theoretically are working on behalf of the patients. Adding to stresses on income are the increased administrative costs that keep doctors from performing their primary duties. The result is that many medical practitioners are leaving the field.

Medicaid pays only about 30% of a doctor's overhead, which means the balance has to be made up with other revenue sources. This is a manageable problem for medical services in metropolitan markets such as Raleigh, Durham, Charlotte and Greensboro where there are a variety of providers and patients willing and able to pay for more profitable elective procedures.

Neither the variety of providers or profitable opportunities exist in most of the state's rural counties. In contrast, many of these counties have already seen a decline medical services as occurred in Beaufort and Warren counties with the closure of hospitals due to lack of funding sources.

Now the legislature has opened the door for more applicants to seek medical services, but the providers are missing. And in cases where the medical facilities are currently adequate, particularly in the rural communities, those same facilities stand to be overwhelmed by demands and under compensated for their services.

The legislature has done a disservice to all concerned. The counties that are currently stressed for medical services will only be more stressed, their constituents will see a decline in services, and the new patients will most likely be left at the door for their care.

What is needed now is an effort to incentivize both medical providers and facility operators to open their doors for these new patients, but that requires financial investment, something the legislature thinks will be coming from either the federal government or new patients. That will not happen.

Health care as a policy needs more input from all parties, which must include the providers.

Now that expanded Medicaid applications open this Monday, time for discussion and finding answers must begin immediately. Otherwise, this effort to provide expanded health care for those who Sen. Berger described as "the hard working North Carolinians who find themselves between a rock and hard place" will be dead on arrival.