CONCORD, N.C. — A Concord small business owner is calling it a miracle after receiving more than $80,000 in previously unpaid Medicaid claims.
"In just a few short weeks, we went from 'on the brink' to very, very hopeful and looking forward to the future again," Peña said. "When I reached out to [WCNC Charlotte] initially, almost four weeks ago, it was, 'I'm thinking I'm going to go bankrupt, have to sell the house, pay all my debt.' From the time of the news story, we've had a tremendous response quickly addressing it."
The Royal Orthotics owner's financial trouble all stemmed from North Carolina's decision to hand over control of its health insurance program for low-income and vulnerable patients to five private companies in July 2021.
More than a year later, executives and bureaucrats alike are finally paying attention to Peña's plight. In addition to reaching out to WCNC Charlotte, he also contacted his state lawmaker and other news outlets. And he says the outreach has helped.
"I'm talking to presidents and vice presidents," he said. "I'm not talking to customer service reps."
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He said his pediatric bracing company's deposit sheet details a flood of long-overdue Medicaid payments, along with penalties and interest, paid by three of the five insurance companies.
He said the $82,000 is more than just money. It represents accountability.
"There's more news, there's more press, maybe there's more pressure to be a little bit more proactive," he said.
Peña said he is now hearing apologies from insurance company executives, but he remains concerned, not for providers as much, but instead for patients, especially kids.
"Children aren't getting the care in a timely fashion or at all," he said. "It hurts me to hear these stories."
WCNC Charlotte investigator Nate Morabito discusses the process behind getting these results with digital producer Matthew Ablon
Despite those anecdotes, North Carolina for Better Medicaid, an organization funded by two of the Medicaid health plans, concluded patients themselves had a favorable view of their health care at the one-year anniversary mark.
"Overwhelmingly, beneficiaries are approving of their health coverage since the transition," executive director Sarah DuBose told WCNC Charlotte.
She cited the results of a recent online survey, which included an oversample of 150 Medicaid beneficiaries.
"It's great to know that, at the end of the day, beneficiaries are receiving the care that they deserve," she said.
Peña isn't quite convinced, but personally, he feels a change. A good chunk of the money he's spent months waiting on is now in hand, which means he won't have to turn away the kids who rely on him for care.
"Are we there yet? No, but we're getting pretty darn close," he said of his financial situation. "We, as a company, can breathe now."
The state has penalized the health plans when they don't live up to their ends of the bargain. Medicaid records show the five health plans that now manage Medicaid in North Carolina have paid just under $1 million, combined, in liquidated damages.
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