The state Health secretary told legislators Tuesday the state remains on pace to submit a Medicaid waiver amendment this fall that includes changes based primarily on recent statewide feedback.

DHHS Secretary Mandy Cohen also informed the healthcare joint legislative oversight committee that while the state is meeting its Children’s Health Insurance Program funding obligation, that could change as soon as February.

There are 221,000 children benefiting from the program, of which 90,000 are at risk of losing federal CHIP funding that helps pay for coverage.

Congress allowed federal authorization for CHIP to lapse Oct. 1. The amount has been about $450 million annually, with more than 90 percent of eligible N.C. youths already enrolled.

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 current request proposes a hybrid public- and private-sector reform solution that eventually would combine physical and behavioral health into a whole-body care platform. DHHS projects about $400 million in savings in the first five years of implementation.

Cohen did not provide specifics about amendment changes, but indicated they are not projected to be controversial to the Trump administration.

Cohen said the goal is gaining CMS approval in the spring, which would allow state health regulators to issue requests for proposals for statewide oversight groups and regional provider-led entities. The current timeline is for three to five statewide groups and up to 10 provider-led entities to chosen in the fall of 2018.

Cohen said achieving a July 1, 2019, launch date “is achievable but ambitious.”

Because the Trump administration had not approved any Medicaid waiver requests to date, Cohen acknowledged North Carolina “is in the queue with several states.”

“We have had a productive first meeting with federal officials, with them noting technical (dollar and cents) things they may not be able to approve,” Cohen said. “We have to maintain budget neutrality.

“We believe we will be able to work through things, but our timeline is very dependent on their timeline.”

Dave Richard, deputy secretary for the state’s Medicaid program, said the Cooper administration 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; and
  • Enhancing successful existing programs, such as care management, while supporting providers and beneficiaries through any changes, such as creating a “one-stop shop” for streamlining beneficiary eligibility and enrollment processes.

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.

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

Several legislators asked about DHHS progress on meeting a legislative deadline for identifying and rooting out Medicaid fraud.

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Health secretary says DHHS is on pace to submit Medicaid waiver amendment – Winston-Salem Journal