DPH and WCHS have a long history of partnering with NC Medicaid to ensure quality services and programs. WCHS staff members serve on a number of different interagency NC Medicaid committees and work teams to plan, coordinate, and evaluate Medicaid services. The current Title XIX Medicaid Inter-Agency Agreement (IAA)/Memorandum of Agreement (MOA) which is included as an attachment to this application details the specifics of areas of coordination and collaboration between NC Medicaid and DPH. A full revision to this IAA/MOA is underway, so the current IAA/MOA will be extended by NC Medicaid for a couple of months in order to finalize the revisions.

The NC Division of Health Benefits’ enrollment dashboard for Medicaid and NC Health Choice (https://medicaid.ncdhhs.gov/reports/dashboards#enroll) reflects the number of people by county and program aid category who are authorized to receive Medicaid or Health Choice services for each report month. According to the NC Medicaid and NC Health Choice Annual Report for State Fiscal Year 2020, in SFY20, NC Medicaid provided access to care and services to 2.2. million people in the state. Many of these people were served through outreach and enrollment efforts of Title V programs and partners. NC Medicaid beneficiaries account for more than 55% of all deliveries which is up from 38% of births in 2006. Through Health Check (Early and Periodic Screening, Diagnostic and Treatment), more than 96% of children under one year of age received all recommended preventive check-ups and more than 59% of all eligible children received periodic screenings on the schedule recommended by the American Academy of Pediatrics.

WCHS and NC Medicaid staff members work together to coordinate outreach efforts for NC Medicaid care management programs serving high-risk pregnant women and at-risk children ages zero-to-five as well as for other programs serving the MCH population such as the NC “Be Smart” Family Planning Medicaid Program. In addition, the C&Y Branch has an outreach team consisting of the Minority Outreach Coordinator, CYSHCN Help Line Coordinator, and CYSHCN Access to Care Coordinator who are committed to increasing the number of children who have health insurance and to enroll eligible children into NC Medicaid/Health Choice (the Children’s Health Insurance Program). A description of their work is found in the Cross-Cutting/Systems Building Annual Report. With the transition to managed care, the WCHS will also participate in the Pediatric Advisory Group and the Maternal Health Advisory Group convened by the Perinatal Quality Collaborative of NC (PQCNC) to provide direct input to the Division of Health Benefits on current projects and ensure quality MCH programs.

Legislation to transform and reorganize NC’s Medicaid and NC Health Choice programs from fee-to-service to managed care was passed in September 2015. NCDHHS was on track to go live with Medicaid transformation on February 1, 2020. However, in November 2019, the NC General Assembly adjourned without providing the required new funding and program authority for the transition to managed care, thus enrollment and implementation for the transition to managed care was suspended on November 19, 2019. With Medicaid Managed Care suspended, NC Medicaid continued to operate under the current fee-for-service model administered by NCDHHS, although providers continued to negotiate contracts with the Medicaid Managed Care health plan which also continued to prepare reporting data and update systems. In June 2020, the NC General Assembly passed legislation that was signed into law by Governor Cooper in July 2020 that mandated that Medicaid transformation happen by July 1, 2021. Despite the suspension and the additional burden placed on NCDHHS and provider to respond to the COVID-9 pandemic, NC Medicaid Managed Care launched on schedule. The goal of the state’s transition to managed care is to improve the health of North Carolinians through an innovative, whole-person centered, and well-coordinated system of care and measurement of quality, which addresses both medical and non-medical drivers of health. NCDHHS created the NC Medicaid Managed Care Quality Strategy which details the aims, goals, and objectives for quality management and improvement and details priority QI initiatives, incorporating the quality activities of all managed care plans, including the Behavioral Health Intellectual/Developmental Disability (I/DD) Tailored Plans, the Eastern Band of Cherokee Indians (ECBI) Tribal Option, and Community Care of NC.

All beneficiaries moving to NC Medicaid Managed Care were enrolled in one of five health plans or the EBCI Tribal Option. All health plans offer the same basic benefits and services, although some health plans offer added services, and some plans may require a copay. The five plans are AmeriHealth Caritas, Carolina Complete Health, Healthy Blue, UnitedHealthcare Community Plan, and WellCare. Beneficiaries had the option of selecting a health plan during open enrollment which ran from March 15 to May 18, 2021. They could enroll by calling the NC Medicaid Enrollment Broker Call Center, going to www.ncmedicaidplans.gov, or using the free NC Medicaid Managed Care mobile app. Those beneficiaries who did not choose a health plan by May 21 were automatically enrolled in a health plan by NC Medicaid, and the auto-enrollment process prioritized existing relationships between beneficiaries and their primary care provider. Federally recognized tribal members living in the Tribal service are who did not choose a health plan were enrolled into the EBCI Tribal Option which is primarily offered in five counties: Cherokee, Graham, Haywood, Jackson, and Swain to federally recognized tribal members and others eligible for services through Indian Health Service (IHS).

All pregnant women enrolled in NC Medicaid Managed Care through a health plan will continue to receive a coordinated set of high-quality clinical maternity services through the Pregnancy Management Program (Pregnancy Medical Home). This program will be administered as a partnership between the health plans and local maternity care service providers. A key feature of the program will be the continued use of the standardized screening tool to identify and refer women at risk for an adverse birth outcome to the Care Management for High-Risk Pregnant Women (CMHRP) program, a more intense set of care management services that will be coordinated and provided by LHDs. Together, these two programs will work to improve the overall health of women and newborns across the state. The Care Management for At-Risk Children (CMARC) program, provided by LHDs for at-risk children ages zero-to-five, promotes use of the medical home, links children and families to community resources, and provides education and family support.

The Behavioral Health and Intellectual/Developmental Disability (BH I/DD) Tailored Plan is scheduled to be launched July 1, 2022. The BH I/DD Tailored Plan will serve individuals with more serious behavioral health disorders (serious mental illness, serious emotional disturbance, and/or substance use disorders), I/DDs, and traumatic brain injuries. NCDHHS is investing in the Tailored Care Management model in which Behavioral Health I/DD Tailored Plan beneficiaries will have a single designated care manager supported by a multidisciplinary care team to provide integrated care management that addresses all of their needs including physical health, behavioral health, I/DD, traumatic brain injuries, pharmacy, and long-term services and supports along with addressing their unmet health-related resource needs.

As part of the transition to Medicaid Managed Care, NC plans to launch Healthy Opportunity Pilots in spring 2022. Up to $650 million in state and federal Medicaid funding has been authorized for these pilots. In May 2021, NCDHHS announced the selection of three organizations to serve three regions of the state. Access East Inc. and Community Care of the Lower Cape Fear are in eastern NC, and Dogwood Health Trust is in western NC. The goals of the pilots are to:

• Evaluate the effectiveness of select, evidence-based, non-medical interventions and the role of the Network Leads in improving health outcomes and reducing health care costs for high-risk NC Medicaid Managed Care members.
• Leverage evaluation findings to embed cost-effective interventions that improve health outcomes into the Medicaid program statewide, furthering the department’s goals for a sustainable Medicaid program.
• Support the sustainability of delivering non-medical services identified as effective through the evaluation, including by strengthening the capabilities of Human Service Organizations and partnerships with health care payers and providers.