All-Provider Meeting September 27, 2017 Medicaid Reform Overview - PowerPoint PPT Presentation

Presentation to the All-Provider Meeting September 27, 2017

Medicaid Reform Overview Capitation • Full capitation • Division of Health Benefits Infrastructure • LME/MCOs remain in current form for 4 years after implementation on physical health side • Up to 12 Provider Led Entities (PLEs) in 6 regions Health Plans • 3 statewide Commercial Plans (CPs) • 1115 Waiver application Timeline • Review, approval and implementation process (approximately 3 years – through July 1, 2019)

What We Know • Move towards a fully integrated system • We are exploring options for the future • Key stakeholders support of a specialty system for individuals with MH/SA/IDD • Recently released NC Medicaid Program Design provides a potential future option for one or more LME/MCOs • Our goal is to have the future of LME/MCO written into the 1115 waiver

DHHS White Paper • NC DHHS released proposal August 8 • Pending legislative authorization, DHHS intends to permit statewide Commercial Plans and regional Provider-Led Entities (PLEs) to develop and offer two types of products: o Standard Plans o Tailored Plans

Types of Managed Care Plans • Standard Plans o Will serve most Medicaid enrollees, including adults and children o Will provide integrated physical health, behavioral health, and pharmacy services at the launch of Medicaid managed care program • Tailored Plans o Previously DHHS referred to these plans as Special Needs Plans or Specialty Plans o Will be specifically designed to serve special populations with unique health care needs

Medicaid Transformation Timeline Key Activity Estimated Date 1115 waiver application submitted June 1, 2016 Stakeholder feedback due August 8, 2017 CMS waiver approval (assumed) January 1, 2018 Medicaid Managed Care RFP issued March 2018 Medicaid Managed Care proposals due June 2018 Medicaid Managed Care awards complete Sept 2018 Medicaid Managed Care go-live July 1, 2019 LME/MCO structure ceases July 1, 2023

Next Steps • DHHS to continue working with stakeholders to refine program design proposal • Late Fall 2017 – DHHS will release a PHP Request for Information (RFI) to: o Solicit additional information from potential PHPs o Assess interest in participation and market readiness o RFI will include additional details about the plan for implementing Medicaid managed care • Also this fall DHHS will submit an amended 1115 Waiver to CMS