Medicaid (copy)
designer491

The administration of Gov. Roy Cooper on Tuesday revealed its proposal for overseeing the state Medicaid reform plan approved by the General Assembly.

The 77-page plan deals with North Carolina’s Medicaid and the N.C. Health Choice programs.

The plan comes 14 months after then-Gov. Pat McCrory’s administration submitted a Medicaid waiver request to the federal Centers for Medicare and Medicaid Services on June 1, 2016. The request did not include expanding the state program for potentially more than 500,000 North Carolinians.

The N.C. Department of Health and Human Services said Tuesday that it plans to submit an amended waiver request to the Centers for Medicare and Medicaid Services by late fall. It did not say what would be included in the amendment.

Dave Richard, the deputy secretary for the state’s Medicaid program, said the Cooper administration’s plan has three main focuses:

  • Integrating whole-body services to combined physical, mental, intellectual and developmental disabilities and substance-use disorders.
  • Tackling unmet social needs and their effect on overall health, such as improving telemedicine access and putting more focus on the state’s opioid addiction crisis.
  • Enhancing successful existing programs, such as care management, while supporting providers and beneficiaries through any changes, such as creating a “one-stop shop” for credentialing and streamlining beneficiary eligibility and enrollment processes.

“This is a well thought out plan that puts Medicaid reform on a strong footing,” said Mark Hall, a law professor at Wake Forest University and a national health-care expert. “I expect that it will be well-received and approved by the federal government.”

The DHHS has struggled, at times mightily, with Medicaid enrollment and eligibility renewal processing, particularly with the food-stamp program, with its NC Fast and NCTracks information-technology programs.

Dr. Mandy Cohen, North Carolina’s secretary of health, and state health regulators submitted their plan about 10 weeks after concluding their own statewide listening tour on Medicaid reform

“We have put forward a detailed proposed design for a Medicaid managed-care system that will deliver an innovative, whole-person-centered, well-coordinated system of care,” Cohen said. “We are grateful for the thoughtful insights provided by hundreds of health-care professionals, beneficiaries and other stakeholders. DHHS welcomes feedback on this proposal.”

Comments will be accepted through Sept. 8.

The request to Centers for Medicare and Medicaid Services proposes a hybrid public- and private-sector reform solution that eventually would combine physical and behavioral health into a whole-body care platform.

The DHHS projects about $400 million in savings in the first five years of implementation.

The McCrory administration reform request was supposed to start a three- to five-year process.

The end goal of Medicaid oversight is services being put into the hands of three statewide managed-care organizations, likely prepaid health plans from commercial insurers, and up to 12 provider-led entities, likely to involve not-for-profit health-care systems.

Each of six regions established by the reform legislation could have up to five provider-led entities providing services. Most recipients will be able to choose whether to be covered by a prepaid plan or a provider-led entity.

However, the request effort has stalled in Washington as the Trump administration struggles to advance in Congress its Affordable Care Act repeal-and-replace agenda. The application remained listed as “pending” Tuesday on the Centers for Medicare and Medicaid Services website.

DHHS officials said Tuesday that they are preparing for a 2019 beginning for Medicaid reforms to managed care.

Prepaid plans would receive a monthly fixed, or “capitated,” payment from the state Medicaid program that the DHHS said “will be actuarially sound, transparent and fair.”

Prepaid plans “will be subject to rigorous monitoring and oversight by DHHS across many metrics to ensure adequate provider networks, high program quality and other important aspects of a successful Medicaid managed-care program,” the agency said.

State Rep. Donny Lambeth, R-Forsyth, the author of the 2016 Republican legislative initiative on Medicaid reform, submitted House Bill 662 during the 2017 session.

The bill was not taken up in a House committee.

The bill, titled Carolina Cares, would have expanded the state program but required “participant contributions.” He said the expansion initiative would work “more like an insurance product for those working who can pay a portion of the cost, and the benefits and coverage are built around preventive and wellness care.”

For example, participants would have to follow protocols for routine physicals and screenings to improve their health if they have such conditions as diabetes, obesity, etc.

On Tuesday, Lambeth said the Cooper administration’s plan “is a good document to capture what (Cohen) has heard in her town hall meetings, and the legislators will continue to work with her to fine-tune our final request as we wrap up the final waiver negotiations.”

“Not all aspects of her vision are yet embraced by the General Assembly,” Lambeth cautioned. “Our discussions may, and I emphasize may, result in an amendment for items the General Assembly agrees to and supports.

“The positive aspect is we are talking to her about this vision and plan and will have that completed in next month,” he said. “I expect her to work with us and not try some unusual maneuver to add an expansion option, so we will be alert to that potential.”

rcraver@wsjournal.com 336-727-7376 @rcraverWSJ