New at 6. A major holdup in
healthcare. It's been a
year since North Carolina,
revamped its Medicaid program,
turning it over to five
private companies to handle,
but some smaller healthcare businesses
are still waiting to get paid.
That's right. In fact,
1 Concord business alone is
waiting on $80,000 worth of claims,
and so, as that owner asks,
where's the money?
A top state official told our Nate
Morabito that he takes personal
responsibility for the failure North
Carolina. That years to prepare
for the Medicaid change that
took effect last summer.
But the companies now in charge
bear some responsibility too.
And we've learned the state.
Find some of them big money
for falling short on promises.
I can't run a
business like this.
Cory Pena is a man of faith.
I'm just like God, help me,
but the rollout of North
Carolina's Medicaid managed
care program we owe $144,000,
has shaken his trust in the government.
We were getting ready to sell our
house and left his pediatric orthotics
business on the brink of bankruptcy.
It's kind of like I'm successful.
But I'm closing my business.
That's devastating.
In November, WCNC Charlotte
first documented Penney's
challenges with the transition.
It allows them to do this and issues
with several of the prepaid health
plans or PHP's that manage the program,
but instead of things improving,
ohh we'll fix it.
Pena says his unpaid claims
have grown to $83,000.
That's what all these? PHP's own us,
forcing him to spend most of
his time right troubleshooting
rather than helping his patients.
It's unfair state records show the Medicaid
Ombudsman's received an especially high
number of complaints in recent months,
more than a third of those tied
to claims and reimbursements.
Meanwhile, data reveal the five
companies running the program
are denying a little more than
one out of every four claims.
I think we're seeing a higher
denial rate that we want.
Dave Richard. Medicaid's deputy secretary.
The numbers that we're seeing,
although concerning they're
very small numbers. Still,
he says the program overall is serving
the needs of low income and vulnerable
patients and largely reimbursing
medical providers in a timely fashion.
But he's also aware the programs
repeatedly failing some small
business owners like Cory Pena.
We thought it had been corrected.
My fault for not digging deeper in
that point to make sure that it had
been $83,000 a year in is ridiculous.
It is. It's it again.
I would say there's no excuse.
You did everything right and we just did not.
We did not deliver and
and that's again on me.
It's on our team.
It's on our health plans and and
we'll get better at doing this as
an extra incentive.
The state is penalizing the
health plans when they don't live
up to their end of the bargain.
Richard says he's made it clear
to those companies they need
to focus on getting it right.
For smaller providers like Pena,
we hate what happened to this one provider.
We think in general that if the program
is going well, we think it will.
Continue to improve, but but we can't
have providers put in this position.
As the program improves,
so does Penney's outlook.
This is a miracle of God.
It took him begging for help,
but he finally feels
hurt. I believe, and trust that this
situation is going to turn around.
It hasn't happened quite yet,
but I'm I'm not selling my house
now full of hope. He's putting his
faith back into the same program.
He says nearly cost him his dream.
Great news. He expects to get a check.
For about $37,000 from one of the
companies, as soon as this week,
Nate Morabito WCNC Charlotte.
And the North Carolina Association
of Health Plans maintains the
Medicaid transition has been among
the smoothest in the nation.
Still in a statement,
the association told us in part,
health plans are working diligently
to address individual provider
issues and identify solutions.
And right now,
on our website and mobile app,
we have several graphs and
tables related to this story,
including a breakdown of the fines these
five companies running the Medicaid
program have paid or had to pay.
Because of these holdups
just click on Nate's story.
On the home page to check it out.