Medicaid Managed Care
On Tuesday, August 8, the NC Department of Health and Human Services released a detailed proposed design on how the State will transform the state Medicaid and NC Health Choice programs from fee-for-service to managed care, a change that is a result of the Medicaid reform law enacted by the General Assembly in 2015.
The proposed managed care design integrates services for physical health, behavioral health, intellectual and developmental disabilities, and substance use disorders while also addressing unmet social needs and their effect on overall health. The proposed design also lays out a transition timeline for how certain aspects of today’s Medicaid program, such as beneficiary appeals and care management, will transition to managed care. The paper describes in detail how data will move throughout the system, how contracts with providers and plans will remain consistent with North Carolina law protections, and DHHS will hold plans accountable for quality care and other standards.
DHHS welcomes feedback on the proposed plan and asks that comments be submitted by September 8, 2017. Duke University Health System is preparing comments in coordination with our office.
With a September 1 deadline, the House and Senate committees overseeing the map re-drawing process have decided on the criteria for the process. In addition to not being able to use election and racial data, 6 other criteria were approved on Thursday:
- Equal population: Based on 2010 census, each district must have roughly the same number of people in it.
- Contiguity: All parts of a district must be connected, but it's acceptable for districts to cross water.
- County groupings: Limit the number of times a district may cross county lines.
- Compactness: Make reasonable efforts to draw districts more compact than the current ones, as measured by a pair of compactness scoring methods.
- Split precincts: Make reasonable efforts to split fewer precincts in the maps than the current ones.
- Municipal boundaries: City and town boundaries can be considered.
Tom Hofeller, a map-maker who drew the maps in 2011 that he is now replacing, should have drafts ready for the public in about two weeks.
Congress is in recess until September 5, and the President is in the middle of a two-week period away from the White House. When Congress reconvenes after Labor Day, it will focus on approving additional appropriations bill, raising the debt limit, and reauthorizing the Children’s Health Insurance Program, all before the end of the fiscal year on September 30.