Heather Leschinsky Administrator II, Managed Care and HCBS Nebraska Department of Health and Human Services Medicaid and Long-Term Care

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1 Heather Leschinsky Administrator II, Managed Care and HCBS Nebraska Department of Health and Human Services Medicaid and Long-Term Care 1

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3 Total Medicaid and CHIP population- 235,000 Currently approximately 188,000 Medicaid eligibles enrolled in Physical Health managed care Approximately 234,000 Medicaid eligibles enrolled in Behavioral health managed care 3

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5 Clients participating in the Aid to Dependent Children Program (ADC and TANF) Clients participating in the Children s Health Insurance Program (CHIP) Clients participating in the Aid to Aged, Blind, and Disabled Program (AABD) Clients participating in the Child Welfare Program Additionally, for Behavioral Health, Medicare primary, clients living in an institution, and those participating in a HCBS waiver are mandatory 5

6 Medicare (dual eligibles) HCBS Waiver, Long-Term Care NF, or ICF/MR Retroactively Eligible (managed care is prospective) Spend down 6

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8 Physical Health-Managed Care Organizations (MCO)-Full Risk Capitated Aetna Better Health UnitedHealthcare Community Arbor Health 8

9 Behavioral Health-Pre-paid Inpatient Health Plan (PIHP) Magellan Behavioral Health Full-risk, capitated for the Behavioral Health services only 9

10 I. The Numbers II. The Basics III. Current Models IV. MLTSS 10

11 MLTSS = Managed Long-Term Services and Supports Currently Nebraska Medicaid is in the development process of a statewide Medicaid managed care program to serve those of long-term services and supports The target implementation date is now July 2018 (originally July 2015, then January 2016, then July 2017) 11

12 Improvement of client health status and quality of life; via better coordination of medical health care, behavioral health care and community-based services and supports To promote client choice and use of the right services and supports (person-centered) Increase client access to responsive, quality services and supports Use financial resources wisely to sustain Nebraska Medicaid 12

13 Full-risk, capitated Integrated benefits package to include physical and behavioral health care, pharmacy, and long-term services and supports (including nursing facility) All Aged, Blind, and Disabled (including those with Medicare primary) Only exclusion being those served by the Developmental Disability programs or living in an ICF/DD 13

14 LB 854 passed during the 2014 Legislative Session and is now law in Nebraska: The Legislature finds that sufficient planning and meaningful input from stakeholders, including, but not limited to, service providers and consumers, is critical for establishing an effective managed care system for Medicaid recipients. To ensure the safety and well-being of the state's most vulnerable population, the Department of Health and Human Services shall not release a request for proposals relating to procurement of managed care for long-term care services and support prior to September 1,

15 LB 690 passed during the 2014 Legislative Session and is now law in Nebraska: Required DHHS to apply for a Balancing Incentive Program (BIP) grant by July 31, 2014 Created the Aging Nebraskans Taskforce 15

16 LB 690 passed during the 2014 Legislative Session and is now law in Nebraska: Required DHHS to apply for a Balancing Incentive Program (BIP) grant by July 31, 2014 Created the Aging Nebraskans Taskforce 16

17 CMS s Final Rule on Home and Community- Based Waiver and State Plans offering HCBS Impacts residential settings in waivers expected to be provided in MLTSS DOL Wage and Hourly Rule for Domestic Workers Impacts many, many individual providers for services expected to be provided in MLTSS 17

18 Engage Legislature s in process and Advisory Council Ensure that issues related to services being carved into a managed care delivery system have solid policy Ensure adequate resources are devoted to design and implementation to avoid delays 18

19 Questions? Contact: Heather Leschinsky 19