Managed Care and Partnership for a Healthy North Carolina

In early April, the Governor McCrory announced a proposal to reform Medicaid  under a new comprehensive Section 1115 waiver that would integrate all Medicaid services (physical health, mental health, long-term care, etc.) into a seamless statewide system under a managed care model known as the Partnership for a Healthy North Carolina.

The proposal would, according to the Governor and DHHS, “implement a coordinated care model of delivery to bring long-term predictability, sustainability and efficiency to the [Medicaid] program.” Citing cost over runs, problems with management of the system and inconsistent services across the state, NC DHHS Secretary Wos and NC DMA Director Steckel have been hosting town hall meetings, speaking about the Partnership  and writing opinion pieces to present the proposal which would have three comprehensive care entities (CCEs) operate an HMO style health care program  covering all aspects of Medicaid services.   These CCEs would likely be private managed care companies, though it may be possible for a public entity to participate in the new system. These types of 1115 waivers are being implemented in other states, but should North Carolina move forward with the proposal, it would be one of the largest and most comprehensive, as it would not carve out things like nursing homes, institutions and services for people with other long term care needs.

North Carolina recently implemented a 1915 b/c combination managed care waiver, in a very short timeframe, for mental health, developmental disability and addictive disease services through eleven regional Managed Care Organizations (MCOs). Some of these MCOs have struggled to manage services, billing and finances under the new system. Secretary Wos has cited those problems and a lack of efficiency in that system as one of the things that would change under the Partnership.  Some have come out in support of changes  while others support making changes to the current system, but not a complete over haul.  Initially NC General Assembly Legislators had many questions about why NC should turn over Medicaid to private managed care organizations  when we had invested in Community Care North Carolina (CCNC) a publicly managed coordinated  care program and 11 new managed care entities for MH/DD/SAS. However, with additional cost overruns in Medicaid, Legislative leaders have now come out in support of the proposal.  The Governor could begin implementing some aspects of the proposal, such as putting forth a plan to the Federal Centers for Medicaid and Medicare (CMS),  but would at the very least need legislative approval and law changes to integrate mental health, developmental disability and addition services from their existing waiver into the new 1115 waiver.  The NC Academy of Family Physicians, along with some other health advocates, have come out against turning over NC’s Medicaid system to private managed care companies and cites the success of public-private partnership programs like CCNC and problems with managed care in other states as well as the need for doctors and providers to have greater input in designing the new system.

It’s not clear what these proposals mean for people with autism and other developmental disabilities under Medicaid who use both the shorter term physical and mental health services as well as longer term services such as the Innovations waiver, group homes, and ICF-MR/IDDs which are fully or  partially funded by Medicaid. Many disability advocates would like to see a streamlined system that integrated care across physical, behavioral and long term care. They would like to see a well managed system that includes individual case management, expertise on autism, consistent high quality services, and less confusion. Similar concerns remain with this new proposal as with the current managed care wavier for developmental disabilities: with little money to be saved by managing long term care, will these populations become the casualty of cost cutting and be forgotten under a larger private managed care system or will there be better care overall? ASNC will continue to monitor these changes and provide input to NC DHHS and NC DMA on the needs of individuals with autism spectrum disorders. Last week, senior staff from ASNC met with DMA Director Steckel to share ideas and concerns about the current system and the new proposal. ASNC plans to continue this dialogue as NC goes forward with designing Medicaid reform.

Additional stories about Medicaid reform proposals can be found at NC Health News.

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