8+ hour, 41+ min ago (847+ words) After facing a substantial deficit for 2026 and 2027, the North Carolina State Health Plan (SHP) now has a surplus, thanks to an increase in premiums, funding from the General Assembly, and other cost-cutting measures. Friedman said their trend this year is running higher than in previous years, and part of that is due to how the plan's third-party administrator, Aetna, pays its claims. The plan's original projected deficit was $507 million in 2026 and between $800 million and $900 million in 2027. In August, the board agreed to raise plan premiums for the first time on a sliding scale based on income, with the smallest increases going to the lowest-paid state employees. The scale is broken down into four income brackets: Under $50,000; $50,001 to $65,000; $65,001 to $90,000; and $90,001 and over. Former State Treasurer Dale Folwell maintained a policy of not increasing premiums, but using cash reserves to offset increases,…...

1+ mon, 2+ week ago (857+ words) The North Carolina State Health Plan announced Wednesday the reinstatement of its "longstanding exclusion of transition-related treatments" typically sought by transgender patients. The announcement arrived on the same day a court case challenging the exclusion officially returned to a federal trial court from the 4th US Circuit Court of Appeals. The 4th Circuit issued a Sept. 23 order in Kadel v. Folwell vacating a trial judge's 2022 decision to block the exclusion. The trial judge had required the State Health Plan to provide coverage for the disputed treatments. The mandate from the Appeals Court's order reached the trial court Wednesday. The decision "reinstates" the State Health Plan's exclusion of transition-related treatments, according to a news release from State Treasurer Brad Briner's office. Briner oversees the State Health Plan. "The exclusion dates back to the 1990s, and while litigation has been ongoing it has continued to appear…...

1+ mon, 2+ week ago (478+ words) More than $6.5 billion in medical debt has been eliminated for over 2.5 million North Carolinians in the past year, according to Gov. Josh Stein, who made the announcement Monday, along with North Carolina Department of Health and Human Services (NCDHHS) Secretary Dev Sangvai. The state's Medical Debt Relief Program, which is being facilitated by Undue Medical Debt, was started in July 2024 by former Gov. Roy Cooper and former NCDHHS Secretary Kody Kinsley. Medical debt remains a big issue for many Americans. A West Health-Gallup Healthcare Survey revealed that 12%, or approximately 31 million Americans, reported borrowing an estimated total of $74 billion in the past 12 months to cover health care costs for themselves or a household member. A majority of Americans (58%) shared concerns that they would experience medical debt if faced with a major health event. But Joseph Harris, fiscal policy analyst for the…...

2+ mon, 6+ day ago (803+ words) In the wake of ongoing negotiations between Duke Health and Aetna, the North Carolina State Health Plan Board of Trustees on Friday approved procuring a transition services vendor to help plan members find new health care providers if an agreement can't be reached by an Oct. 20 deadline. Duke Health says that unless Aetna raises its reimbursement rates, many patients will lose in-network coverage to Duke's doctors, hospitals, clinics, and services, including over 750,000 state employees covered under the State Health Plan. Aetna is administrator of the SHP, which is the company's largest customer in the state and is responsible for half of its member base in North Carolina. About 22,000 members have Duke as their primary care provider, and approximately 40,000 members have filed a claim through Duke this year." State Treasurer Brad Briner, whose office oversees the health plan, said it would…...

2+ mon, 1+ week ago (760+ words) In an emailed statement to Carolina Journal on Friday, Duke Health said it is "actively engaged in good faith negotiations" with health insurance company Aetna, in response to a story that many patients, including over 750,000 state employees covered under the State Health Plan (SHP), will lose in-network coverage to Duke's doctors, hospitals, clinics, and services on Oct. 20. Aetna is the administrator of the SHP, which is the company's largest customer in the state and is responsible for half of its member base in North Carolina. Duke's demands don't sit well with State Treasurer Brad Briner, whose office oversees the SHP. After the State Health Plan Board of Trustees voted'unanimously'last month'to approve premium increases for 2026 due to a budget shortfall, he told Carolina Journal in a phone interview on Sept. 17 that the State Health Plan simply doesn't have the money for…...

2+ mon, 2+ week ago (933+ words) Listen to this story (9 minutes) The clock is ticking on negotiations between health insurance company Aetna and Duke Health, which says that unless Aetna raises its reimbursement rates, many patients will lose in-network coverage to Duke's doctors, hospitals, clinics, and services on Oct. 20, including over 750,000 state employees covered under the State Health Plan (SHP). Aetna is the administrator of the SHP, which is the company's largest customer in the state and is responsible for half of its member base in North Carolina. Duke's demands don't sit well with State Treasurer Brad Briner, whose office oversees the SHP. After the State Health Plan Board of Trustees voted'unanimously last month'to approve premium increases for 2026 due to a budget shortfall, he told Carolina Journal in a phone interview that the State Health Plan simply doesn't have the money for another increase. In a…...

3+ mon, 2+ week ago (653+ words) In a much anticipated move the State Health Plan Board of Trustees voted'unanimously'to approve premium increases'for the more than 750,000 members of the State Health Plan (SHP) on Friday.' In February the board met to try and find a solution to the plan's projected deficit$507 million in 2026 and between $800 million and $900 million in 2027.' On May 20th, the board reconvened and approved changes to the SHP benefits, raising annual deductibles for singles and families under the 70/30 (Standard PPO) and 80/20 (Plus PPO) plans starting in the 2026 benefit year.' State Treasure Brad Briner whose office oversees the SHP said this was necessary to keep the plan functional in the future.' "I walked into office in January with a half a billion-dollar deficit and that's just for 2026. Today, we're going to take the last step to filling the hole by finalizing premiums," said Briner. "I know…...

3+ mon, 3+ week ago (710+ words) Healthcare premiums for 770,000 North Carolina State Health Plan (NCSHP) members in 2026 will be decided at the next NCSHP Board of Trustees meeting on Aug. 15. They are likely to increase because they haven't increased in eight years. At the board's meeting in May, North Carolina State Treasurer Brad Briner said cash reserves had been used to offset any changes to the plan, but the plan is almost out of reserves, necessitating the change. He said at the meeting that premium increases for the lowest-paid employees were only expected to rise $5 per month rather than the $20 per month that was originally projected when they last met in'February, thanks to work by the SHP team and the federal subsidy. In addition, the plan's projected deficit " $507 million in 2026 and between $800 million and $900 million in 2027 made the changes necessary not only to the premiums, but…...

4+ mon, 2+ week ago (985+ words) Listen to this story (9 minutes) An audit of North Carolina's Medicaid program has revealed numerous issues that the Office of the State Auditor says pose a threat to patient safety. Among them, how the North Carolina Department of Health and Human Services (NCDHHS) allowed providers with license limitations, suspensions, or other credential issues to remain in the program. North Carolina State Auditor Dave Boliek released the audit on Thursday. He said it was conducted to determine if DHHS had implemented changes for similar issues found in a 2021 audit. The 2025 audit found that leadership didn't fully fix the issues, leaving those on Medicaid and taxpayers vulnerable to fraudulent and potentially dangerous behavior. Auditors had four findings: Auditors also noted that providers with non-practice agreements were not removed from the Medicaid program and continued to serve Medicaid patients, receiving payment from the…...

5+ mon, 5+ day ago (602+ words) A new performance audit from the North Carolina Office of the State Auditor (NCOSA) concurs with State Treasurer Brad Briner and the North Carolina State Health Plan Board of Trustees that the State Health Plan (SHP) is in serious financial trouble. The State Health Plan provides health coverage to nearly 750,000 state employees and retirees. North Carolina State Treasurer Brad Briner and SHP administrators have said the plan's projected deficit was $507 million in 2026 and between $800 million and $900 million in 2027. As a result, the SHP Board of Trustees voted in favor at their May meeting to raise deductibles, among other changes. The audit, based on actuarial projections from 2024, which were used for financial forecasting by the State Treasurer's Office, showed net losses for the SHP of $199 million, $507 million, and $862 million for 2025 through 2027. Ultimately, the projections showed the State Health Plan having a…...