The legislature finally adjourned the 2019 session for the final time earlier this month, but that doesn’t mean the feuding and finger pointing in Raleigh has ended.

The latest round is about Medicaid transformation, which is entirely different and separate from Medicaid expansion – the reason the state still doesn’t have a budget.

Medicaid transformation is a bipartisan plan to change the way Medicaid bills are paid by the state from fee based, where the state pays every bill, to managed care, where the state pays a certain amount per person to insurance companies and the insurance companies are responsible for paying the bills. The insurance companies make a profit if they can negotiate the healthcare bills to a lower cost than the state pays them.

The Medicaid transformation plan is supposed to save the state money and provide better health care for those on Medicaid.

Medicaid transformation has been in the works for several years and the money to put the plan in place was part of the state budget that Gov. Roy Cooper vetoed.

Then the legislature, as one of the “mini-budgets,” passed a separate $502 million Medicaid transformation bill that Cooper also vetoed. At the time, Cooper said that passing the budget piecemeal was not good policy, but he signed other mini-budget bills.

This week North Carolina Department of Health and Human Services Secretary Dr. Mandy Cohen said that without funding the Medicaid transformation roll out, which was supposed to happen on Feb. 1, it would be delayed indefinitely.

Cohen also said that once the process of changing over to a managed care system was stopped, it couldn’t be easily restarted.

State Sen. Joyce Krawiec (R-Forsyth), chair of the Senate Health Care Committee, said that not going forward with Medicaid transformation will force the insurance companies to lay off thousands of employees hired to handle the Medicaid transformation process.

Cooper blames the legislature and the legislature blames Cooper, which is what has been going on all year.

The decision to delay indefinitely the Medicaid transformation should not affect Medicaid recipients whose care will continue to be paid for on the fee based system.