Q&A with Brian Ingram, president and CEO of Vaya Health, talks about Medicaid changes

Aug. 2—About 27,000 local people are eligible for Medicaid, and many more struggle to get healthcare without it. There is a lot to be learned about how North Carolina's Medicaid transformation will impact those particularly vulnerable people.

Brian Ingram, president and CEO of Vaya Health, helps us get started.

Vaya Health is an LME/MCO, that's local management entity/managed care organization, which is a state government organization that looks a lot like a private company competing with others like it. It recently agreed to swallow up Alamance County's LME/MCO Cardinal Innovations and manages services in 22 North Carolina counties and counting. It's also in the process of turning into a "tailored" plan under North Carolina's Medicaid transformation that went into effect July 1.

Editor's note: This article has been edited for content and space.

In the simplest terms what does Vaya Health do?

Essentially we're a public managed care company and we are responsible for managing the care for individuals that have Medicaid or have no insurance or are sometimes simply underinsured, or individuals that have problems with mental illness, substance abuse disorders or intellectual and developmental disabilities.

What percentage of Alamance County's population would be directly affected by Vaya Health?

So, under the system that we were part of until Medicaid transformation took place, and that was July 1, there were roughly 27,000 individuals in Alamance County that would have been eligible to have a service or to have us manage their care. ... That does not include individuals that do not have Medicaid and would be eligible to receive care given the limits of funding. So in the new world of tailored plans ... beginning hopefully next July, that number would be reduced to about 7,400 individuals.

What about the other 20,000 people?

They can receive care through a standard plan depending upon which insurance company — PHP [prepaid health plan] they've signed up for. ... There are four insurance companies that won statewide contracts and they have been marketing to individuals to sign up for care through their plans.

This is a pretty radical change in what you do.

We'll be dealing with a much smaller population of individuals that have the greatest need for care. We'll also be responsible in the near future for physical health and pharmacy.

With this new system, will there be fewer people — not eligible for Medicaid — who won't have the opportunity to get treatment?

You have to appreciate, the [mental health] crisis system is very, very heavily used by people that do not have Medicaid, and that probably ranges from 60% to 70% of the individuals that are going to be receiving crisis service. ... Is the question (will) the ratio of individuals to be greater who are non-Medicaid? I think you could say, yes. Because when you create types of services, people take advantage of them. And when they're not available, you get individuals that end up in other places that are not as well suited like the emerge department, getting involved in the criminal justice system; systems that aren't really designed to specifically meet their needs.

Isaac Groves is the Alamance County government watchdog reporter for the Times-News and the USA Today Network. Call or text 919-998-8039 with tips and comments or follow on Twitter @TNIGroves.

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