Collaborating for Success in Medicaid Transformation. Jennifer Snow, Director of Public Policy, NAMI NAMI NC Conference October 12, 2018

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1 Collaborating for Success in Medicaid Transformation Jennifer Snow, Director of Public Policy, NAMI NAMI NC Conference October 12, 2018

2 Outline Medicaid Overview Eligibility Benefits Service Delivery Demonstration Waivers Integrated Care North Carolina s Demonstration Waiver

3 Medicaid Plays a Critical Role in our Health Care System Health Insurance Coverage For 1 in 5 Americans Assistance to 10 million Medicare Beneficiaries > 50% Long-Term Care Financing MEDICAID Support for Health Care System and Safety-Net State Capacity to Address Health Challenges Source: KFF

4 Medicaid Flexibilities Effectively 56 different Medicaid programs (50 states, 5 territories and DC) States establish their own Eligibility standards Benefit packages Service delivery Administrative structures Demonstrations allow additional flexibilities

5 Medicaid Eligibility Populations Children Pregnant Women People with Disabilities People over age 65 Financial Criteria Medicaid expansion

6 North Carolina Medicaid Eligibility 250 Percentage of Poverty Level Infants under age 5 Pregnant women Children aged 6-18 SSI Recipients Parents Young adults Medically Needy Spend Down 0 Other adults

7 Medicaid Eligibility Expansion Before ACA, only certain low-income people qualified for Medicaid ACA required states to expand coverage to those not previously eligible for Medicaid; Supreme court decision made expansion optional

8 Medicaid expansion landscape Expanded Medicaid 33 states + DC have adopted Medicaid expansion Over 15 million people became insured as a result *Maine and Virginia have adopted the Medicaid expansion but it has not yet taken effect.

9 Medicaid expansion landscape Expanded Medicaid Not expanded 17 states have not expanded Medicaid 1.9 million uninsured people with a mental health or substance use condition live in states that has not yet expanded Medicaid

10 Medicaid expansion landscape Expanded Medicaid Considering Expansion Not expanded 3 more states considering expansion through ballot initiative

11 Medicaid Benefits Mandatory Inpatient hospital services Outpatient hospital services Nursing Facility Services Home health services Physician services Rural health clinic services Federally qualified health center services Laboratory and X-ray services Family planning services Nurse Midwife services Nurse Practitioner services Freestanding Birth Center services Transportation to medical care Tobacco cessation counseling for pregnant women Optional Personal care services Physical therapy services Prescription drugs Primary care case management services Other diagnostic, screening, preventive, and rehabilitative services Home and community based services Inpatient hospital and nursing facility services for individuals age 65 or older in institutions for mental diseases Inpatient psychiatric services for individuals under age 21 Targeted case management services Occupational therapy services

12 Service Delivery Fee-For-Service (FFS) the state pays providers directly for each covered service received by a Medicaid beneficiary. Managed care plans the state pays a fee to a managed care plan for each person enrolled in the plan. In turn, the plan pays providers. Comprehensive-risk based managed care Primary care case management (PCCM) Limited-benefit plans

13 Figure 13 Two-thirds of all Medicaid beneficiaries receive their care in comprehensive risk-based MCOs. WA OR NV CA AK ID AZ Share of Medicaid beneficiaries enrolled in risk-based managed care plans UT MT WY CO NM ND SD NE KS TX OK MN IA MO AR LA WI IL MS IN MI TN AL KY OH WV GA SC PA VT VA NC FL NY ME NH MA CT RI NJ DE MD DC HI U.S. Overall = 65% >0-50% (13 states) 0% (5 states) 51-80% (20 states, including DC) >80% (13 states) SOURCE: Medicaid Managed Care Enrollment Report, Summary Statistics as of July 1, 2015, CMS, 2017.

14 Medicaid Demonstrations Section 1115 demonstration waivers allow Secretary to grant flexibility Likely to assist in promoting the objectives of the Medicaid program Each Administration has some discretion over which waivers to approve and encourage Currently 44 waivers approved in 37 states Many waivers expand services or coverage, like: ACA expansion waivers Behavioral health services enhancements Delivery system reform waivers Managed long-term services and supports Other targeted waivers (i.e., Flint, MI water crisis; HIV-AIDS, foster care children)

15 Benefits of Integrated Care Triple Aim: Improving the health of populations, Enhancing the experience of care for individuals, and Reducing the per capita cost of health care

16 NC s Medicaid Demonstration Transition to Managed Care Strengthening workforce Telemedicine Focus on those with behavioral health needs Tailored Plans (in Years 3-4) Integrated physical, behavioral health and pharmacy services to those with SMI, SED and SUD. Intensive community-based care management Specialized care managers Specialized clinical supervisions IMD waiver request

17 Questions? Thank you. Jennifer Snow Director of Public Policy, NAMI

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