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Senators passed a package of changes to the state's health insurance program for the poor and uninsured on Tuesday, but not before once again rejecting a bid to expand Medicaid coverage to roughly 500,000 North Carolinians who are uninsured. The Senate voted 34-10 to return House Bill 372 to the House. Under the Senate version of the measure, North Carolina would use a blend of managed care companies and locally created "provider-led entities," or PLEs, to manage Medicaid. The House version of the bill relied exclusively on PLEs, and leaders there say the chamber is almost certain to reject the Senate version. That would trigger a conference committee to work out differences and draft a final bill. (Binker, 8/11)

The bill would change the current fee-for-service system to a per-member monthly allotment, meant to encourage patients and medical providers to control costs in the Medicaid program. It calls for a mix of commercial insurers and in-state health-care providers. It would create a new cabinet-level department of Medicaid, with a secretary appointed by the governor and confirmed by the legislature. (Jarvis, 8/11)

The Senate's formula for overhauling how North Carolina's Medicaid program should pay for patient treatment has been approved with some Democratic support. Five Democrats joined all Republicans voting Tuesday to back the proposal, which would replace the current fee-for-service system with one that invites private insurance companies and regional hospital and doctor networks to enter into state contracts. (8/11)