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Medicaid Transformation & Recovery from COVID-19

Mandy Cohen, MD, MPHSecretary

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Moving to NC Medicaid Managed CareVision: Improve the health of North Carolinians through an innovative, whole-person centered, and well-coordinated system of care that addresses both the medical & non-medical drivers of health.

Goal for July 1 launch: Individuals get the care they need and providers get paid

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Moving to NC Medicaid Managed Care• 1.6 million Medicaid beneficiaries are now enrolled in

one of 5 Prepaid Health Plans (PHPs) • AmeriHealth Caritas, Healthy Blue, United HealthCare, WellCare,

Carolina Complete Health (Regions 3, 4, 5)

• All health plans, all regions will go live on July 1, 2021.

• Some beneficiaries will stay in fee-for-service because it provides services that meet specific needs, or they have limited benefits. • This will be called: NC Medicaid Direct.

• Medicaid eligibility does NOT change

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Key things to Remember• 97% of beneficiaries were enrolled in a plan that includes

their current primary care provider (PCP) in-network

• Beneficiaries will receive a welcome packet from their health plan with a new Medicaid ID card

• Beneficiaries have through September 30th to change their health plan for any reason

• All providers will be paid as “in-network” for the first 60 days

• Existing Prior Authorizations are honored for the first 90 days

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Getting your questions answered:

Provider Ombudsman Contact Email: Medicaid.ProviderOmbudsman@dhhs.nc.govPhone: 919-527-6666

Check in NCTracks for the Beneficiary’s enrollment (Standard Plan or Medicaid Direct) and Health Plan. If you still have questions, call the NCTracks Call Center: 1-800-688-6696

Connect with the Health Plan (PHP) for coverage, benefits, and payment questions. You can find a list of health plan contacts at NCDHHS’ Transformation website

Consult with the Provider Ombudsman on unresolved problems or concerns.

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COVID-19 Response & Recovery

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COVID Trends: Where We are Today CovidTrackingProject.com

Data drives all our decision-making; NC is ranked top in the nation for data collection

COVID-LIKE ILLNESS DAILY NEW CASES

TESTINGHOSPITALIZATIONS

2.3%

COUNTY ALERTSYSTEM

June 10th edition

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Lessons Learned1. We need to build for “system-ness”

− Data exchange; shared tech platforms; align measures and incentives to health

2. Solving for “Health” requires a broad lens− Care and access beyond walls; Cross sector collaboration linking

communities and health care; pay for non-medical services

3. Measuring the equity problem is necessary but not sufficient

− Need to map investments and changes in payment and delivery models to the data

4. We must focus on building and maintaining trust

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NCCARE 360NCCARE360 is the 1st statewide coordinated network

that unites health care and human services organizations with a shared technology platform allowing for a coordinated, community-oriented,

person-centered approach to delivering care in NC.

Client Care Coordinator

Food Provider Employment Provider

Food and other needs identified

Additional needs identified

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NCCARE360 in Action“Our practice received a message from [the patient] recently

stating she was contacted by ‘an extremely sweet person’

(NCCARE360) that is now trying to find a program for vets

to help w/ utility bills and find someone for her mental

health concerns. She is finding some hope in her situation,

just because someone reached out to her and is helping her

find the resources she deserves – not only as a vet, but as a

human being! It also gives me hope that I have a resource

that will help our families. Thank you.”

- Raleigh Pediatrics

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Healthy Opportunities Screening, Assessment & Referral (HOSAR)• To claim reimbursement for positive Healthy Opportunities

screenings under the HOSAR payment program, providers completed a screening covering beneficiary needs related to the Department’s four priority domains:

– Food insecurity– Housing instability– Lack of transportation– Interpersonal violence

As of May 2021:2332 Claims Paid$74K in payments

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Health Equity Payment• Enhanced payment to primary care practices

serving disproportionate share of beneficiaries from high needs / socioeconomically distressed areas.

• April – June 2021 ~$50M total payments• Increased PMPM based on Poverty Score – calculated as

practice's mix of beneficiaries (measured by poverty rate at beneficiary's census tract).

*Thresholds centered around average Poverty Score of 19.4%

Poverty Score by Practice (NPI/Location)

Enhanced PMPM Payment

# of Practices (NPI/Loc)

Tier 1: <17.4% $0 1,353

Tier 2: 17.4% - 21.4%* $9 828

Tier 3: >21.4% $18 802

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Healthy Opportunity Pilots• Feds authorized up to $650M in Medicaid funding to test

evidence-based, non-medical interventions designed to improve health outcomes and reduce healthcare costs for high-need Medicaid enrollees

• Vast majority of funds will pay for non-medical services: food, housing, transportation, and interpersonal violence/toxic stress

• 3 Regions were selected through a competitive procurement of Network Leads.

• The remainder of 2021 will be used for building the network of service providers and other capacity building activities

• Start to pay for new non-medical services in the 3 regions in early 2022.

• You will be able to refer eligible patients for these new services through care managers and NCCARE360.

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Pilot Regions

Network Lead Regions

Access East, Inc.

Community Care of the Lower Cape Fear

Dogwood Health Trust

Beaufort, Bertie, Chowan, Edgecombe, Halifax, Hertford, Martin, Northampton, Pitt

Bladen, Brunswick, Columbus, New Hanover, Onslow, Pender

Avery, Buncombe, Burke, Cherokee, Clay, Graham, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Polk, Rutherford, Swain, Transylvania, Yancey

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What Services Can Members Receive Through the Pilots?

North Carolina’s 1115 waiver specifies 29 services that can be covered by the Pilot. Examples include:

Housing• Housing navigation,

support and sustaining services

• Housing quality and safety inspections and improvements

• One-time payment for security deposit and first month’s rent

• Short-term post hospitalization housing

Transportation

• Linkages to existing transportation resources

• Payment for transportation to support access to pilot services, (e.g., bus passes, taxi vouchers, ride-sharing credits)

Interpersonal Safety

• Case management/ advocacy for victims of violence

• Evidence-based parenting support programs

• Evidence-based home visiting services

Food• Linkages to

community-based food resources (e.g., SNAP/WIC application support)

• Nutrition and cooking education

• Fruit and vegetable prescriptions and healthy food boxes/meals

• Medically tailored meal delivery

See Appendix for the full list of 29 services with definitions associated fees.

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Funding NC’s Ongoing Response & Recovery from COVID-19

• The American Rescue Plan Act (ARPA) of 2021 is the sixth COVID-19 relief bill and is estimated to provide about $1.9 trillion in federal spending nationwide. In total, NC expects to receive about $1.7 billion.

• These funds will support the state’s ongoing response to and recovery from the pandemic, as well as infrastructure investments, including:− Child Care− Care for Older Adults & their Families− Nutrition Assistance− Assistance for Low-Income Families− Mental Health and Substance Abuse− COVID-19 Vaccines and Testing− Public and other Health Provisions− Medicaid/CHIP− And More

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COVID-19 Recovery

• NC Medicaid increased provider payment rates and enhanced payments to providers who serve long-term care and home and community-based services will sunset at the end of the public health emergency

• NC Medicaid greatly expanded telehealth policies to allow significant amounts of telehealth practices, many of which will continue after the end of the public health emergencyo Need to expand access to broadband

• ARPA has new supports for Medicaid home and community based services: o These additional federal funds can enhance, strengthen, and

sustain services for Medicaid beneficiaries requiring home-based services.

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Medicaid ExpansionMedicaid Expansion – ARPA provides two years of enhanced funding for the whole Medicaid program for newly expanding states

o North Carolina could receive approximately $1.7B in new federal funds over 2 years (in addition to the $4B per year in federal dollars) if the state decides to expand Medicaid

• Medicaid Expansion states experience improvements in self-reported mental health, decreased burden of opioid overdose and death, and statewide economic growth

• Medicaid Expansion would disproportionately help rural residents, strengthen rural hospitals and providers, and financially benefit rural communities

• More than 500,000 uninsured employees will have health insurance helping many small and essential business maintain a healthy workforce

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Questions?

@SecMandyCohen

Questions?

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