Yesterday Secretary Cansler presented to the Health and Human Services appropriations committee the Department's plan to expand the medicaid waiver (b) (c) statewide by July 2013.  Many of you may know that PBH (the local management entity that has served Cabarrus, Davidson, Rowan, Stanly and Union counties) has managed a waiver program with very good outcomes for a number of years.  What are these good outcomes?  Not as many people needing high end hospitalization services due to more effective community services is certainly one good outcome, along with good general satisfaction of those who live there.  It is of course not without problems, however.  Managing a waiver is a very difficult proposition.

 

What exactly is a waiver?

• Combines all medicaid funded service recipients into one capitated funding model (the managing authority takes an amount from medicaid up front and they must use that to meet all the needs within the next year)
• The LME assumes the risk in managing this pool of money- they must manage it well or they will run out of money
• One tool they have is to manage the provider network- it is no longer any willing and qualified provider, but those providers who they choose because of good outcomes.
• Expected goals include better access, improved quality, increased cost efficiencies, and predictable medicaid costs (rather than constantly rising costs)
• The manager of the system can also control rates- at PBH in rural areas where they had trouble attracting psychiatrists at the limited rate, they could in fact offer more.  This could lead to performance based contracting (the better the outcomes, the higher the pay)
• In the Secretary's proposal, we would maintain a publicly run system through the LMEs rather than through a private entity.
• With successful waiver administration, there are savings that can be put towards creative, innovative services that may not be typical medicaid reimbursable services - like using peers more creatively, more housing options, respite care, etc.  Check out the successes in the Supported Housing as an Alternative to Psychiatric Hospitalization final report (as a way of doing creative services)  PBH does quite a bit of peer support and has developed at least one additional crisis center. 
• This model is intended to eventually contain the growth of medicaid (cost containment and in fact savings)

 

 

What's next?

 

Implement the waiver in ECBH (19 counties), Sandhills (8 counties), Western Highlands (8 counties) and possibly at some point Mecklenburg

  

An RFA was released April l with goal to identify new sites by August 2011; readiness review process ongoing

  

The plan is to increase the minimum population threshold to 300,000 by 7/12/12 and to 500,000 by 7/1/13 for LMEs to qualify for management of a waiver.  This may reduce the number of qualifying LMEs to 8-10.  Smaller entities may contract with another LME to manage their medicaid and state money, while they maintain a local presence in their counties. 

  

1. Get involved with your LME- give them your input- if you feel you need more housing, more crisis care- tell them, and ask them the role of consumers and family members in shaping policy
2. Get educated - attend meetings on this topic that may be occurring locally
3. Talk to people at PBH about their experiences with the waiver (our President, David Bullins, lives in the PBH region)
4. Share your concerns and your hopes about the waiver with me at NAMI NC or any board member
5. This is more change, and we've had a lot of that in NC- it is important that this lead to improvement, not the general chaos of change not managed well.