In 2011, the NC General Assembly passed House Bill 916 (now SL 2011-264). It mandates that North Carolina’s Mental Health, Developmental Disability, and Substance Abuse (MHDDSA) system of care convert to a Managed Care System by January of 2013. The shift happens in stages, with many areas of our state already affected. While The Arc has concerns about managed care for people with intellectual and developmental disabilities, we understand the state will convert to this system.
A major issue with the new design is the replacement of independent Case Management with Care Coordination provided by the Managed Care Organization (MCO). Though we understand that Case Management as it currently exists will not be available in Managed Care sites, we believe individuals should have someone not working for the MCO responsible for writing their person centered plan and to assist them in finding the appropriate service providers. Otherwise, a conflict of interest exists.
In addition to the need for independent care coordination, we also are concerned that the current design inhibits the ability of individuals to move from one county to another without service interruption, and that Medicaid rules around County of Origin (the county where the participant first recevied services) will limit services available to individuals.
In an effort to make NC’s system more responsive, The Arc is recommending a modest set of changes to members of the General Assembly. These changes would establish independent care coordinators not working for the MCO to assist in writing Person Centered Plans and to help find the appropriate services providers. Additionally, it would require that Innovations Medicaid Waiver Slots be portable, and that where a person first received Medicaid not become a barrier for services.
These changes will have no impact on the budget that the NC House and Senate are currently working on and will not cause cost increases in future years. MCOs may have to change the way they organize Care Coordination, but with careful planning that involves qualified agencies, families, and consumers, we believe the cost to MCOs will be minimal.
It is important to note that our proposal does not restore Case Management, but rather builds upon the option that is already available in the law- Care Coordination. Our proposal requires MCOs to contract these functions for people not on the Innovations Medicaid Waiver and assures that people on Innovations have the option for an Independent Care Coordinator.
Many members of the General Assembly want to help with this plan but they need to hear from their constituents.
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