Despite optimism early this week over a Senate budget conference position proposal that made serious concessions to the House budget position, we are at a new stalemate Friday.

The Senate budget position including reducing their proposed trimming of the Medicaid rolls and leaving only $30 million between House and Senate funding levels. Then Senators Hise and Pate rolled out a new plan for the structure and operation of Medicaid and the machine has screeched to a halt - and the screeching you hear is doctors and hospitals objecting to the introduction of managed care providers running our Medicaid system. 

Under the proposal provider-led accountable care organizations or managed care organizations would run the state's Medicaid system and pay a flat per patient amount for all care for that patient. A spokesperson representing physicians testified that the additional administrative paperwork related to this approach, should it be enacted, would certainly hurt access to medical care for the poor. Currently nearly 90% of primary care physicians in NC take Medicaid. Florida, which uses this managed care approach have a much lower participation rate.

The House and the Governor have already voiced their opposition to the plan. And we don't need to remind you that this brand new proposal was unveiled two weeks after the Legislature should have adjourned for the year.

Have a look at the Senate's plan here: http://www.ncleg.net/Sessions/2013/Bills/House/PDF/H1181v4.pdf