1115 Waiver Update
The Joint Medicaid and NC Health Choice Oversight Committee met on March 1, 2016 to review the Department of Health and Human Services 1115 waiver draft. This waiver is a demonstration project for a fully capitated Medicaid program in North Carolina. Here are several of the key points that were presented to the committee:
1. 1115 Waiver draft was met with rather good support from legislative leadership.
2. I/DD was mentioned in the way of a DD health home.
3. It is clear the new contracts will be stronger and will have built into them more rewards for meeting outcomes and also stronger punitive measures if you miss desired health outcomes. (these are contracts with the PHP and PLE)
4. There were no changes to current legislation/statute to benefit the long term existence of the LME/MCO network. This means that the original time line of four years after the first contract still stands.
5. There was no discussion about state dollar services or how they fit into this plan.
6. There was discussion and presentations around the need for one standard credentialing system, one billing system and one data system. Also a need for more robust HIE in order to make this entire thing work. Rates were also discussed; it is clear that rates in some areas of Medicaid will need to be raised prior to capitation.
7. The only legislative changes suggested were the following: do not include CDSAs in the waiver, do not include Medicaid services from LEAs in the waiver and permit parents of kids in foster care to remain on Medicaid while their child is in foster care to set up a way for the family to be reunited.
What's next…there will now be a series of listening sessions/public comment across the state.
Here is the link to the DHHS Medicaid Reform website with all the waiver information: http://www.ncdhhs.gov/nc-medicaid-reform.
Comments can be made on the 1115 draft until April 18th, 2016 here: http://www.ncdhhs.gov/nc-medicaid-reform/share-comments.