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Swain to support Medicaid expansion Cherokee Hospital wants to expand services to non-natives BY J ESSI STONE N EWS EDITOR wain County Board of Commissioners plans to pass a resolution showing the county’s support for Medicaid expansion in North Carolina following a presentation from Casey Cooper, CEO of the Cherokee Indian Hospital. “In North Carolina, there are 600,000 people who would be eligible for coverage with expansion and Swain is among the highest number of uninsured working adults,” he said. “Western North Carolina suffers disproportionally. Swain is ninth in the state for highest uninsured working adults. It’s a little startling. Most people are one catastrophic illness away from bankruptcy to be quite honest.” Cooper told commissioners during a July 8 meeting that closing the Medicaid gap is one of the Eastern Band of Cherokee Indians’ No. 1 priorities right now and showing state lawmakers that Western North Carolina counties also support it would be critical as the General Assembly works toward a budget. In his presentation, Cooper said 23 percent of working adults in Swain County are uninsured and that an estimated 1,100 residents would gain access to coverage with Medicaid expansion, according to data from the Cone Health Foundation. Expansion would mean new jobs in Swain as well as an estimated $3.9 million in new business spending because of the ripple effect from more health care spending. In Cherokee, another 1,000 people would become eligible for Medicaid and would create another $7 million in revenue for the tribe’s health care system. “The tribe is already funding this $7 million worth of services, but this care just isn’t being provided elsewhere or the hospitals are absorbing it as unfunded care,” Cooper said. In his conversations with Steve Heatherly, CEO of Harris Regional Hospital in Sylva and Swain Community Hospital in Bryson City, Cooper said closing the health insurance gap would represent $5 million a year in increased revenue for the Swain and Harris health care system. Cooper also tried to clear up many of the
Smoky Mountain News
July 28-August 3, 2021
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rumors he’s heard from those who are changing it again would literally take an act of opposed to expanding Medicaid. He said one Congress to amend the act, which is unlikely of the biggest misperceptions is that people to garner enough support from both the who receive Medicaid are unemployed and Senate and the House. The Cherokee Hospital Authority operunwilling to work. “About 63 percent of uninsured are work- ates with 800 employees and $100 million in ing adults — these are working poor folks,” gross revenue a year. The authority has seen he told commissioners. “And women repre- substantial growth to the tribe’s health care sent the largest portion of uninsured adults system since taking over management from in business sectors. A lot of times these are the federal government in 2012, Cooper said. Since the Qualla Boundary is located partsingle moms with a couple of kids that are on Medicaid but they themselves are going with- ly in Jackson and Swain counties, Cooper said out coverage.” Right now, Cooper said even Cherokee Hospital Authority leadership recently asked health care plans through the Swain County commissioners to support a resolution to Affordable Care Act’s marketexpand Medicaid in North Carolina. Donated Photo place are out of reach for many people. He said if a person makes more than $7,000 a year, they don’t qualify for the ACA subsidies, which makes the ACA marketplace plans unaffordable. When ACA first passed, the federal government incentivized states to expand Medicaid by promising to pay 100 percent of the state’s cost for the first three years and 90 percent of costs after that. Still, North Carolina and other states chose not to expand because it only makes since for the hospital authority they didn’t trust the federal government to to be able to provide health services for nonnatives in the community as well. Expansion keep that promise in perpetuity. “At the end of year three, expansion would would make that possible. “We want to make services available to cost North Carolina $5 billion a year but because of ACA the cost will be matched by non-natives, especially for behavioral health the feds at 90 percent, the state’s match is and substance use, but the challenge is feder$500 million a year,” Cooper said. “People say al regulations requires us to only do that if the that’s still too much but it’s not a bad return service can’t be reasonably available elsefor the match and the hospitals and insur- where in the area,” he said. “The second criteance companies have agreed to fund 90 per- ria is we have to charge the minimum of cost cent of the state match through assessments and finally we have to demonstrate that it so now it’s only $100 million — that’s a $350 doesn’t result in a decline in services for natives. We feel comfortable we can meet million return on investment.” Cooper added that the latest stimulus those criteria if more people in the communipackage added more incentives for states to ty had health coverage.” Being able to access the resources on the expand Medicaid, which means North Carolina is eligible to receive an additional boundary would help surrounding county $1.7 billion in the two years following expan- agencies save money and time, especially when it comes to finding a behavioral health sion. “The feds want us to expand because they bed for someone suffering from a mental health or substance abuse emergency. know closing the gap works,” he said. Swain County Commission Chairman The question that always gets asked is, “What if the feds change their minds on Ben Bushyhead said law enforcement officers matching?” To that, Cooper told the board are required to sit with someone who has that the matching incentives are written into been involuntarily committed in the emeran amendment of the Social Security Act and gency room until a behavioral health bed can
Vaya Health awarded health plan by N.C. DHHS The N.C. Department of Health and Human Services selected Vaya Health to operate a health care plan for North Carolina residents with mental health needs, substance use disorders or an intellectual or developmental disability. The Vaya Health Behavioral Health I/DD Tailored Plan is expected to launch July 1, 2022. As part of the statewide shift to Medicaid managed care, Vaya will serve Medicaid beneficiaries and uninsured or underinsured residents of
more than 22 N.C. counties who have significant behavioral health needs, as well as people who receive services through or are on waitlists for the N.C. Innovations and Traumatic Brain Injury (TBI) waivers. Under the new plan, Vaya will also manage members’ physical health care, pharmacy services and long-term services and supports. Based in Asheville, Vaya currently serves 22 counties in Western North Carolina. Vaya announced on June 1 plans to consolidate with Cardinal Innovations Healthcare Solutions, a peer organization serving parts of central North Carolina, and will manage the Tailored Plan in additional counties currently aligned with Cardinal
be found for the patient. Sometimes it can take days for a bed to open up and often that bed can be on the other side of the state. The lack of behavioral health beds in the state has cost local law enforcement agencies a lot of money in recent years. “That’s been a huge expense for us,” he said. Commissioner Kenneth Parton asked Cooper if he was worried an expansion of Medicaid would not cause a flooding of people into the Cherokee healthcare system. “No. We have quite a bit of capacity because we built to future forecast. Also because we anticipated that to have sober healthy communities we knew we’d need extra capacity,” Cooper said. “If there’s paying demand, we could provide more services.” Swain County Commissioner Kevin King said he wanted to brag on the Cherokee Hospital Authority for how they’ve administered health services for the past several years. What the tribe has done has set an example for the state’s roll out of Medicaid Transformation. “Cherokee hospital has taken managed care to the next level. What they’ve already done with their members is what the state is trying to do now,” King said. “Cherokee has case managers that walk with a person through the entire process and plugs them into any service they need. The state is basically copying what’s already taken place on the boundary.” Cooper said he’s hopeful that expansion could happen in North Carolina this year. While it’s in Gov. Roy Cooper’s budget, expansion isn’t included in the House budget and doesn’t look like it will be in the Senate’s budget either. However, he said he’s heard that when both chambers bring their budgets to conference there will possibly be a negotiation on expansion. “That’s the rumor so it’s paramount to send a message to the House and the Senate that it’s OK to expand,” Cooper said. The commissioners voted to draft a resolution to support Medicaid expansion and would present it for approval at the next meeting. The vote passed 4 to 1 with Commissioner Parton opposed.
Innovations upon plan launch. Under North Carolina’s transition to Medicaid managed care, most Medicaid beneficiaries have already transitioned to one of five Standard Plans or the Eastern Band of Cherokee Indians Tribal Option, which launched July 1, 2021. The state’s Tailored Plans will cover the same services as NC Medicaid Standard Plans and offer additional specialized mental health, substance use, I/DD and TBI services. At this time, Vaya members will see no changes in the services they receive. Members seeking more information can call 800.849.6127.
