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NC DHHS Releases Plan for Medicaid Reform

The NC Department of Health and Human Services has issued a proposed design for Medicaid managed care in North Carolina. The proposal gives individuals on Medicaid, families, caregivers, providers, and other stakeholders the opportunity to share feedback before DHHS submits a revised waiver to the Centers for Medicare & Medicaid Services (CMS) in the fall.

Transformation of the NC Medicaid system will change most of Medicaid from a fee-for-service system to a managed-care system that uses an integrated-care model. Several years ago, North Carolina’s developmental disability, mental health, and substance use disorder system moved to managed care: a system in which managed-care organizations (MCOS) receive a set amount of money per Medicaid recipient and must manage those funds to pay for all services. If health needs are not managed well, the MCO is at financial risk and must cover the additional costs.

In addition to managed-care changes, Medicaid will integrate physical and behavioral health care for people with mild to moderate mental health and substance use treatment needs.

The basics of what these changes mean are outlined here.

When will these changes take place?

This is a draft proposal from NC DHHS that still requires approval by the federal government and is subject to change by the NC General Assembly. The earliest these changes would start is July 2019, but approval for Medicaid system changes could take several years, and “tailored plans” for individuals with intellectual and/or developmental disability (IDD) would not be implemented for several more years. It is also unclear what changes to Medicaid may be proposed by Congress that would mean changes to the NC transformation proposal.

How will this affect individuals with autism and other intellectual and developmental disabilities?

The proposed plan includes the option for a “tailored plan” or plans that would go into effect two years after the rest of the Medicaid transformation. Tailored plans would serve about 85,000 individuals with IDD including autism, as well as individuals with significant mental health and/or substance use disorders. The goal is to provide people in these plans with necessary specialized services as well as access to physical health-care needs. Outlines of NC’s tailored plans for IDD begin on page 21 of the proposal.

Many unknowns remain when it comes to how IDD services will work under a tailored plan, among them: How will services under an IDD waiver ensure that “integrated care” is provided? What kinds of services will be available for non-waiver Medicaid participants and those on the waiting list? If Medicaid expands, what kinds of services will be available for people with autism, considering that behavior services are not currently required under “Medicaid expansion” proposals?

Opportunity to express your opinion on the new plans!

The public has the opportunity to provide feedback on the plan – both what’s in it and what may be missing – until September 8. Send comments to Additional ways to submit comments are listed here.

Read the entire proposal here.


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