Thread by @rosehoban

#medicaid presentation. We've had budget surpluses for years. Any issues could be covered.
"This is a year unlike any other in the 50 year history"
convergence of new managed care program and pandemic uncertainty.
Pandemic has increased costs for providers, the program

The good news is that the bump up in #Covid_19 spending has continued longer than we expected. Even tho there are more beneficiaries, there's more federal $$ flowing into program. Projected higher budget, but @ncdhhs had difficulty projecting by how much

Highlights of #Medicaid budget: Expanded coverage for post-partum, more waiver slots, new $$$ for home and community block grants, funding for child services reorganization, then there's IT costs. Lots going on for @ncdhhs

@ncdhhs DHHS also has lots of $$$ from #ARPA including: testing, vaccine admin, #behavioralhealth supports for families affected by #pandemic.
@ncdhhs going after @fema dollars for soem #Covid_19 costs

@ncdhhs @fema Looking for small amounts of $$$ from feds, savings, #COVID19 money to see where we can find resources to cover #Medicaid costs. #ncga

@ncdhhs @fema Now @KodyKinsley back at podium, looking to see how they can increase access to care, services. "I see these as investments" #behavioralhealth #publichealth infrstructure and #children's services

@ncdhhs @fema @KodyKinsley "We want to stick the landing on this year's budget" @KodyKinsley

@ncdhhs @fema @KodyKinsley Of note, @KodyKinsley has finally cut his hair. Gone is the #pandemicponytail

@ncdhhs @fema @KodyKinsley question from Rep. Adcock about how #managedcare has affected the #medicaid budget, different funding models for care.
Anodyne answer.

Models from other states to "entice" providers to participate in #Medicare
Ans: looking at what model for reimbursement creates best incentive

@ncdhhs @fema @KodyKinsley Slide on the screen talks about:
- convergence of #managedcare & pandemic uncertainties
_ actual enrollment > expectations
- COVID response costs
- COVID response to skilled nursing facilities
- change in hospital financing approach (H383) #ncga

@ncdhhs @fema @KodyKinsley Rep Lambeth says not a surprise to see enrollment up, we went out and encouraged it. The hope is that over the long term, people's needs will decr as they get care. "I know you're trying to keep everything within budget, I know it's a challenge this year" #ncga

@ncdhhs @fema @KodyKinsley Se Bergin, in your modeling for next few years where do you see us getting the benefit of #medicaid #managedcare and will we get to surpluses? I know #redeterminations will take time.
CFO: excellent question!
We do know that in "normal times" it takes ~3 yrs to get to savings

@ncdhhs @fema @KodyKinsley Over several years, costs start to go down, we'll adjust budget according to projection. The big mystery is when do effects of #pandemic on #medicaid go away. There's been so. much. change. that we could not forsee when we put in budget request in February. #ncga

@ncdhhs @fema @KodyKinsley At this point, capitation rate for indiv is relatively high.
Sen Bergin, if we stay the course, you think that in 3 yrs we'll see #medicaid surplus again?
CFO: question of surplus is difference between projection and what comes to be. This past year was really hard to project.

@ncdhhs @fema @KodyKinsley It could be as soon as next year that we have a surplus.
@KodyKinsley in hindsight, if we had #medicaidexpansion, we would have paid less for many of the folks who qualified for #Medicaid - bc of #COVID19 - over the past two years

@ncdhhs @fema @KodyKinsley Also there's a LOT of money we're having to pay to #skillednursingfacilities because of their "extraordinary" staffing challenges.
CFO: we're within days of needing to decide wh to continue the SNF $$$ bump up for another month. #ncga

@ncdhhs @fema @KodyKinsley Rep White: what services are people still getting as a result of #medicaid additions from the #pandemic
CFO: we received funding to support myriad of services throughout the pandemic.

@ncdhhs @fema @KodyKinsley Rep Lambeth: part of the rationale getting into #managedcare is to slow the growth of #medicaid
For years, bf we got the "right budget" we did better forecasting. and then we had surpluses bc we did better projecting.
Still holding out home that #managedcare will slow $$ growth

@ncdhhs @fema @KodyKinsley In a couple years, we should see reductions. we can't control # of enrollees, but the indiv spend is the issue. Hoping that #managedcare will reduce that spend.