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HB 1181 - Establishes Commercial Managed Care for Medicaid Recipients - North Carolina Key Vote

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Title: Establishes Commercial Managed Care for Medicaid Recipients

Vote Smart's Synopsis:

Vote to pass a bill that establishes a managed care Medicaid system operated by a private board.

Highlights:

  • Establishes the framework for the implementation of a commercial managed care Medicaid system including, but not limited to, the following components (Sec. 2):
    • The full-risk capitated-rate health plans for all Medicaid recipients;
    • The competition for regional contracts between private, non-provider-led plans and hospital, provider-led plans; and
    • The regional health plans with multiple choices for participants and at least 1 provider-led plan.
  • Establishes the Department of Medical Benefits to administer and operate the managed care Medicaid and NC Health Choice programs (Secs. 1 & 10). 
  • Specifies that the Department will be responsible for certain duties including, but not limited to, the following duties (Sec. 10):
    • The employing of the Medicaid director and others to staff the department;
    • The entering into contracts for the administration of the Medicaid and NC Health Choice programs; and
    • The establishing of all components of the Medicaid and NC Health Choice programs, except for eligibility requirements which will be determined by the legislature.
  • Requires the Department to be governed by a private Board, composed of the following 7 individuals (Sec. 10):
    • 1 expert in the administration of large health delivery systems appointed by the Governor;
    • 1 expert in public assistance programs appointed by the Governor;
    • 1 actuary with experience in health insurance appointed by the Governor;
    • 1 expert in managed care appointed by the General Assembly on the recommendation of the President Pro Tempore of the Senate;
    • 1 business leader with experience on a corporate board appointed by the General Assembly on the recommendation of the President Pro Tempore of the Senate;
    • 1 expert in health insurance appointed by the General Assembly on the recommendation of the Speaker of the House of Representatives; and
    • 1 business leader with experience on a corporate board appointed by the General Assembly on the recommendation of the Speaker of the House of Representatives.
  • Establishes the Joint Legislative Oversight Committee on Medical Benefits to examine the operation of Department of Health and Human Services, Department of Medical Benefits, Medicaid, and NC Health Choice programs (Sec. 12).

Title: Establishes Commercial Managed Care for Medicaid Recipients

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