Medicaid Transformation: A Changing System.

1. Medicaid Transformation: A Changing System. NCAPSE Spring 2019 Conference Julia Adams Scheurich

2. How Medicaid funds flow to NC today NCGA

3. Vision for Medicaid ManagedCare - DHHS • “Improving the health and well-being of North Carolinians through an innovative, whole-person centered and well- coordinated system of care that addresses both medical and non-medical drivers ofhealth.”

4. Medicaid Transformation = Change is coming • Requires Medicaid to move to an at risk, capitated, managed care 1115 waiver • 1115 waiver is the federal authority used to accomplish the foundations set forth in the state law • We currently operate under the 1915b/c waiver • Moves away from a fee for service model for services outside of the LME/MCO. • Vision of reform is to deliver whole-person care through coordinated physical health, behavioral health, intellectual/developmental disabilities and pharmacy products and care models. • Includes Social Determinants of Health. • Address the full set of factors that impact health, uniting communities and health care systems • https://www.ncdhhs.gov/assistance/medicaid-transformation

6. How did we get here?

7. PHPs for NC Medicaid ManagedCare for Standard Plans • Statewidecontracts • AmeriHealth Caritas North Carolina,Inc. • Blue Cross and Blue Shield of North Carolina,Inc. • UnitedHealthcare of North Carolina,Inc. • WellCare of North Carolina,Inc. • Regional contract – Regions 3 &5 • Carolina Complete Health,Inc.

8. NC Medicaid Managed Care Regions and RolloutDates – DHHS Standard Plans REGION2 NOV.2019 REGION4 NOV.2019 REGION6 FEB.2020 ALLEGHANY NORTHAMPTON ASHE GATES SURRY WARREN STOKES GRANVILLE ROCKINGHAM CASWELL PERSON VANCE HERTFORD REGION1 FEB.2020 HALIFAX WATAUGA WILKES YADKIN ALAMANCE DURHAM FORSYTH ORANGE GUILFORD BERTIE AVERY FRANKLIN NASH ALEXANDER IREDELL CALDWELL DAVIE EDGECOMBE YANCEY MADISON MARTIN WASHINGTON TYRRELL DAVIDSON WAKE DARE BURKE CHATHAM WILSON RANDOLPH CATAWBA ROWAN MCDOWELL BUNCOMBE PITT BEAUFORT HAYWOOD JOHNSTON HYDE SWAIN GREENE LINCOLN LEE RUTHERFORD CABARRUS HARNETT WAYNE HENDERSON GRAHAM STANLY MOORE JACKSON GASTON POLK CLEVELAND LENOIR CRAVEN MONTGOMERY MECKLENBURG TRANSYLVANIA MACON CHEROKEE PAMLICO CLAY CUMBERLAND JONES SAMPSON RICHMOND HOKE REGION3 FEB.2020 UNION ANSON DUPLIN ONSLOW CARTERET SCOTLAND ROBESON BLADEN PENDER REGION5 FEB.2020 COLUMBUS BRUNSWICK Rollout Phase 1: Nov. 2019 – Regions 2 and4 Rollout Phase 2: Feb. 2020 – Regions 1, 3, 5 and6 2019 0204

10. Feb March April May • Initial letter sent to beneficiaries in 2counties • Address verification letter sent to remainingcounties 2019 • Flyers posted atDSS • Address corrections toDSS • 2nd letter tomembers • Member Outreachactivities • Public ServiceAnnouncements • PHP marketingmaterials June3RD • EB Call CenterOpen • Welcome Packetsmailed SOFT LAUNCH July Aug Sept Oct • Open Enrollment Begins - July15th • Open Enrollment Ends - Sept13th • Members auto assigned to PHPs based onalgorithm • •Member ID cards • MemberHandbooks Nov1ST Day 1- Regions2 &4 Managed Care Launch- Phase1 Dec • Memberfeedback • Evaluation of materials,process

11. June3RD July Aug • EB Call CenterOpen • OutreachActivities • Flyers posted atDSS • Address corrections toDSS • Letters tomembers • Member Outreachactivities 2019 Sept2 SOFT LAUNCH nd Enrollment WelcomePackets Oct Nov Dec Jan • Open Enrollment Begins- Oct14th • Open Enrollment Ends- Dec13th • •Member ID cards • MemberHandbooks 2020 Day 1- Regions1, 3, 5 &6 Feb1st Managed Care Launch- Phase2 March • Memberfeedback • Evaluation of materials,process

12. How will people know which plan we are in? This Photo by Unknown Author is licensed under CC BY-NC-ND

13. Maximus: The Role of the Enrollment Broker

14. Beneficiary Experience – AutoAssignment Beneficiaries who don’t choose a health plan will be assigned one automatically, consistent with the following components in this order: Where the beneficiarylives. Whether the beneficiary is a member of a special population (e.g. member of federally recognized tribes or BH I/DD Tailored Plan eligible). If the beneficiary has a historic relationship with a particular PCP/AMH. Plan assignments of other familymembers. If the beneficiary has a historic relationship with a particular PHP in the previous twelve (12) months (e.g.,“churned” off/into Medicaid ManagedCare). 9

15. The Prepaid Health Plans: Benefits BothStandardPlansandBHI/DDTailoredPlanswillbeintegratedmanagedcareproducts and will provide a robust set of physical health, behavioral health, long-term services and supports, and pharmacybenefits. Create single point of accountability for care and outcomes forMedicaid. StandardPlans TailoredPlans • Beneficiaries benefit from integrated physical & behavioral healthservices • “Primary care” behavioral health spend included inPHP capitationrate • Phased implementation– • Nov. 2019 & Feb.2020 • Specialized managed careplans targeted toward populations with significant BH and I/DD needs • Access to expandedservice • array • Behavioral HealthHomes • Projected for July 2021 3

16. Standard Plan

17. Tailored Plan

18. Tailored Plan Design and LaunchTimeline Until early 2020, DHHS will be conducting intensive planning for both Standard Plans (SPs) andTPs. After SPs launch, DHHS will continue implementation planning for TailoredPlans. BH I/DD TPdesign (8/2018-2/2020) BH I/DD TP implementationplanning (2/2020-7/2021) SP implementationplanning (8/2018-2/2020) DHHS awardsBH I/DD TPcontracts (tentative) DHHSreleased SPRFP SPs launch ininitial regions BH I/DDTPs launch (tentative) SPs launch inremaining regions; DHHS releases BHI/DD TP RFA (tentative) DHHS issuesSP contracts MCAC BH/IDD SUBCOMMITTEE, FEB. 4,2019

19. Tailored Plan Eligibility • Qualifying I/DD diagnosis Innovations and TBI Waiver enrollees and those on waitlists • Qualifying Serious Mental Illness (SMI) or Serious Emotional Disturbance (SED) diagnosis who have used an enhanced service Those with two or more psychiatric inpatient stays or readmissions within 18 months • Qualifying Substance Use Disorder (SUD) diagnosis and who have used an enhanced service • Medicaid enrollees requiring TP-only benefits • Transition to Community Living Initiative (TCLI) enrollees • Children with complex needs settlement population • Children ages 0-3 years with, or at risk for, I/DDs who meet eligibility criteria • Children involved with the Division of Juvenile Justice of the Department of Public Safety and Delinquency Prevention Programs who meet eligibility criteria • NC Health Choice enrollees who meet eligibility criteria

20. Tailored Plan Simplified

21. Tailored Plan Simplified

22. Tailored Plan Simplified

23. How can I learn more about the tailored plans? • DHHS has a lot of information: • Behavioral Health/IDD Tailored Plan: https://medicaid.ncdhhs.gov/behavioral-health-idd-tailored-plans • Has link to all the previous webinars including the slides and a transcript of the presentations. • Link to the Eligibility and Enrollment Paper: https://files.nc.gov/ncdhhs/BH-IDD-TP-FinalPolicyGuidance-Final-20190318.pdf • Next white paper from DHHS will be on care/case management.