GREENSBORO, N.C. — As kids across the Piedmont get ready to head back to school, one local mom says her son does not have everything he needs to start a new year.
Alysia McCracken is at a standstill, trying to help her 12-year-old son get new medication and testing his doctors recommended at Cornerstone Behavioral Health in High Point.
“It’s incredibly important because we want him to be successful. In order for him to be successful in school, he needs to have this testing and have medication changed,” McCracken explained. “And we can’t do that until we get through step one!”
Step one? For the state to approve her son’s treatments and testing through Health Choice, a state health insurance program.
McCracken said doctors first started the process for prior approval in June and again in July. “They re-submitted it August 1. It’s August 12. We still don’t have approval,” she said. “What about kids with severe special needs? What’s happening to them?”
“This is the system grinding to a halt. This is dysfunctional,” said Dr. David Talbot with Cornerstone Health in High Point.
He said problems like what the McCracken family is experiencing are part of the state’s transition to NC Tracks, a new online Medicaid billing system.
NC Tracks replaced a 35-year-old outdated system, according to the NC Department of Health and Human Services. FOX8 has recently reported a variety of issues and payment delays connected to the new system.
DHHS tells us they expected to have a 30-90 day rough patch after the transition to the new system July 1.
Dr. Talbot said that time frame is unacceptable.
“We are seeing patients who need x-rays or other procedures, and we can’t get pre-approval. We can’t get through,” he said. “It’s all connected,” he added, saying the issues started July 1 when NC Tracks was first implemented.
Dr. Talbot said reimbursements from the state Medicaid program have essentially halted for Cornerstone’s providers.
“This is hurting the people in our communities who are already most vulnerable,” he added.
McCracken called Medicaid caseworkers and DHHS representatives but says, so far, no one had a solution to get her son’s approval process started. School starts for him in less than two weeks.
Medicaid providers, she said, may have known the changes were coming. But her family did not.
“We should have had some communication this change was going to occur so we could have been prepared,” insisted McCracken.
The State Dept. of Health and Human Services told FOX8 they do not believe prior approval is tied to NC Tracks. They have forwarded this to the NC Tracks team to investigate.