NC Medicaid Update

NC Medicaid Expansion Enrollment Dashboard Availalbe with Monthly Updates to Enrollee Data

ACMESA continues its strong working relationship with the Department and Jay Ludlam, Deputy Secretary, Medicaid and met in person last week as we press on with the needs of providers and patients you serve. Jay sent the below update to share with you: 

The North Carolina Department of Health and Human Services (NCDHHS) launched a dashboard to track monthly enrollment in NC Medicaid for people eligible through expansion. 

The NC Medicaid Expansion Enrollment Dashboard offers a detailed overview of enrollment trends in newly eligible adults ages 19-64 who can now apply for full health care coverage.

On day one of expansion, nearly 273,000 people were enrolled and covered by Medicaid expansion, most of which were part of the family planning population who were automatically moved to full coverage. The platform provides a look at enrollee characteristics that include age, race, ethnicity and other demographics. Information on the percentage of eligible adults newly enrolled in NC Medicaid by county and type of health plan, as well as specifically within rural areas of the state, is also available.

The dashboard represents a snapshot of enrollments known at the beginning of each month and does not capture enrollments processed after the start of the month. This new dashboard for Medicaid expansion is in addition to the department’s existing NC Medicaid Enrollment dashboard.

NC Medicaid Providing Free, Printed Educational Materials for Medicaid Expansion and Enrollment

NC Medicaid is providing free, printed educational materials for partners to distribute to individuals and families seeking more information about Medicaid expansion and enrollment. Sign up today for these informative materials that include NC Medicaid Toolkit materials and swag items available in English and Spanish. Materials will begin shipping (at no cost) in January.

To order your materials, please fill out the print materials order form below by Jan. 8, 2024

CMS Provides Additional Clarity Regarding 2024 DMEPOS Reimbursement

The VGM Government Relations team shared their deep dive into the current state of reimbursement, the CPI-U adjustments, blended rates, and other noteworthy changes coming in 2024. Learn more about each of these updates below. 

Patients’ Right to Freedom of Choice of Providers

Patients have the right to choose the providers that render care to them. This right is extremely important. Just imagine if you were told that you had to receive care from a specific provider that you did not choose, especially if you thought the care provided was substandard. And yet, at least anecdotally, providers often forget the importance of this right and ride roughshod over it! After all, even patients enrolled in managed care organizations (MCOs), including Medicare Advantage Plans, have the right to freedom of choice. They can always decide to pay for care themselves even if MCOs will not.

There are several sources of patients’ right to freedom of choice of providers:

Court decisions, or the common law, clearly state that all patients have the right to control the care that is provided to them, including who renders it. 

Federal statutes also guarantee the right to freedom of choice of providers to both Medicare and Medicaid patients.

Specifically, 42 CFR 1395a, Section 1802 states as follows:

"(a) Basic freedom of choice. – Any individual entitled to insurance benefits under this title may obtain health services from any institution, agency, or person qualified to participate under this title if such institution, agency, or person undertakes to provide him such services…"

The Balanced Budget Act of 1997 and Conditions of Participation (CoPs) for discharge planning of the Medicare Program also affirm patients’ right to freedom of choice of providers.

CoPs of the Medicare Program for Long Term Care Facilities reaffirm the right of all patients to “free choice” and state that every resident has the right to self-determination. The CoPs also indicate that every resident has the right to be free of coercion and to participate in the planning of care and treatment.

Finally, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services, the primary enforcer of fraud and abuse prohibitions, has clearly stated that violations of patients’ rights to freedom of choice also violate applicable fraud and abuse prohibitions. In “OIG Compliance Program Guidance for Nursing Facilities,” for example, published in the Federal Register on March 16, 2000, the OIG stated that denial of a resident’s right to participate in care and treatment decisions may constitute fraudulent conduct.

Some states have laws regarding patients’ right to freedom of choice. Perhaps one of the most eloquent of these statutes is in Arizona and states as follows:

“The power to require or regulate a person’s choice in the mode of securing lawful health care services, or to impose a penalty related to that choice, is not found in the Constitution of the United States of America, and is therefore a power reserved to the people pursuant to the tenth amendment. This state exercises the sovereign power to declare the public policy of this state regarding the right of all persons residing in this state in choosing the mode of securing lawful health care services.”

The statute goes on to say:

“It is the public policy of this state, consistent with all constitutionally enumerated rights, as well as those rights otherwise retained by the people, that every person in this state may choose or decline to choose any mode of securing lawful health care services without penalty or threat of penalty.”

Patients’ right to freedom of choice of providers is also firmly rooted in ethical principles. All patients clearly have the right to autonomy.

Now is the time to renew the commitment to honoring this essential right.

©2023 Elizabeth E. Hogue, Esq. All rights reserved.

No portion of this material may be reproduced in any form without the advance written permission of the author.