12.05.2018 BOH Meeting MinutesNC Medicaid Reform Update – December 2018
In 2015 NC session law 2015‐245 directed NC DHHS to transition NC Medicaid to a managed care model
(from a predominantly fee‐for‐service model). NC DHHS designed, with much input from all stakeholders
including public health, a managed care system that goes beyond simple transition to a managed care
payment system. This transition has been designed to address both medical and non‐medical drivers of
health. Some examples of this are Behavioral Health Integration, Specific Opioid Epidemic Strategy, and
Healthy Opportunities Pilots. Further information about the demonstration waiver can be found on the NC
DHHS webpage dedicated to this project: https://www.ncdhhs.gov/assistance/medicaid‐transformation
NC DHHS applied to CMS (Center for Medicare & Medicaid) for a “1115 Medicaid Waiver” Nov, 2017.
NC DHHS received CMS approval for a five‐year demonstration project October 19, 2018.
Current Status: NC DHHS is in a “quiet period” until awarded vendors announced
Innovative: The NC Medicaid Managed Care Demonstration is designed to invest Medicaid funds
in highly effective medical care, and also in supports beyond traditional healthcare
spending to combine all aspects of Medicaid spending to facilitate whole‐person care
Scope: The approved NC Medicaid “1115” waiver is a five‐year “demonstration project”
(1/1/19 to 10/31/24); The waiver covers Medicaid paid services only (but could
influence private payer policy and practice over time); this demonstration project will
have two evaluation publications, one in the middle of the project and one at the end,
both will be conducted by an outside contractor.
Budget Neutrality: CMS policy requires spending be “budget neutral”, i.e. North Carolina cannot spend
more than it projected to spend without the waiver.
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Potential Impacts to New Hanover County Public Health:
Billing/Reimbursement:
Will bill to each managed care entity servicing Medicaid enrollees in New Hanover County
Medicaid Cost Settlement – per CMS policy, no longer allowed, likely to be phased out, NC DHHS looking at
options to make safety net providers (incl local public health) whole via other funding channels
“carve out” services continuing in fee‐for‐service status (i.e. Dental only NHCPH service for certain)
Personal Health Services:
(Immunizations, Maternal Health, School Mental Health, Child Health, STD, Family Planning, etc.)
May have a mix of managed care services and “carved out” fee‐for‐service services
Could potentially affiliate with a CIN (Clinically Integrated Network)
Our health services reimbursements are not expected to be greatly affected
Credentialing planned to be centralized (with/for all PHPs*)
CC4C and OBCM Care Management: (Community Care 4 Children, Obstetrics Care Management)
2 years first refusal – PHPs required to contract w/ LHDs for CC4C & OBCM a “similar rates”
LHD will be responsible for communicating with PHPs records system(s), or join a CIN
After 2 years these services will be open for bid, moving toward a “market‐based” system
All Care Mgmt responsibility will transition to PHPs and must be paid from capitation funding
We do not know exactly how this may affect our revenue levels for these programs
Nutrition/WIC:
Little to no impact to core WIC services
Potentially impacting professional nutrition services for Medicaid reimbursement
MDU (Mobile Dental Unit): no impact, dental remaining in fee‐for‐service structure
Community Health Services: (Communicable Disease, TB, etc.)
Little to no impact
Health Education: no discernable impact
Environmental Health: no discernable impact
Partner Impacts:
Many Medicaid paid services are provided by local partners and we are familiarizing ourselves with those
potential impacts as well – to enable us to provide better leadership through the transition
Some examples are: Medicaid enrollment and management at NHC Social Services; CAP‐C, CAP‐DA services;
PACE services to the elderly; services to children under an IAP via NHC Schools.
*PHP = Prepaid Health Plan
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