CMS denies North Carolina's proposal to pay down docs' debt

The CMS on Wednesday approved North Carolina's Medicaid waiver to transition to managed care, but it denied the state's request for more federal funds to pay off doctors' student loan debts.

North Carolina officials wanted to use $45 million from the feds to attract more doctors to treat Medicaid beneficiaries by offering a loan repayment and incentive program. But the CMS said it did not have enough data to approve the request, according to a notice on its site.

The state can study the gaps in its provider workforce and submit a waiver request suggesting how it would address any shortages it finds to the CMS, the agency said.

North Carolina claimed the funds could have helped attract general surgeons, OB-GYNS, psychiatrists, psychologists and midlevel behavioral health providers.

The CMS also denied the state's request to impose work requirements and premiums on Medicaid enrollees. Both measures targeted Medicaid expansion adults, but the state never passed legislation to officially expand Medicaid.

Beyond allowing managed care in the state, the CMS approved a request for plans in the state to tackle social determinants of health through a pilot for enhanced case management services, awarding the state $650 million for that program. Under the demonstration, insurers will identify and target populations of high-need Medicaid beneficiaries and determine a specific package of services tailored to that individual's need.

These extra services could include several housing-related services, such as helping beneficiaries find a place to live or offering repairs for mold, pest infestation or malfunctioning heating or air conditioning systems.

Other enhanced services include providing food after a hospitalization and transportation to pharmacies, grocery stores and social engagement activities such as church and parks. The CMS has authorized $650 million to pay for enhanced case management services through 2024.

North Carolina is the first state in the country to embed a program like the enhanced case management pilots into its Medicaid managed-care delivery system, according to the CMS.

"As we seek to create a healthcare system that truly rewards value, we must consider the impact that factors beyond medical care have in driving up health costs," CMS Administrator Seema Verma said in a statement.