Information About Wake County's Medicaid 1915(b)(c) Waiver Process
UPDATE: November 7, 2011
The Wake County Board of Commissioners voted unanimously to proceed with a proposed merger between the Local Management Entities (LME) of Wake County and Durham County during their regularly scheduled board meeting on November 7, 2011. If approved by both parties, the merger would become effective July 1, 2012, and create the state’s largest Managed Care Organization (MCO) for public behavioral health and disability services based on population, serving almost 1,690,000 residents.
The merged MCO would serve a four-county region including Wake, Durham, Johnston and Cumberland counties, and would begin managed care operations under the 1915 (b)/(c) Medicaid Waiver program on January 1, 2013. The new MCO would be comprised of leadership and staff of both organizations with Ellen Holliman, currently Area Director of The Durham Center, serving as CEO. It would also have a new name and branding, with offices in both counties.
Why is Wake County merging with Durham County?
On November 2, 2011, Wake County learned that its application for the 1915 (b)/(c) Medicaid waiver program did not meet the minimum requirements to move forward in the waiver approval process.
After denying Wake’s applications, DHHS presented the County with the following options:
- work with DHHS to request an extension and proceed with efforts to establish a single county MCO; or
- partner with another LME that had received approval to proceed in the process to operate as an MCO with a Medicaid Waiver.
After thoroughly discussing the available options with behavioral health clients, providers, advocates and other stakeholders – and substantial research from its leadership team – Wake decided to pursue a merger with The Durham Center. The close geographical proximity of The Durham Center, combined with their demonstrated innovative, high-quality services that result in positive outcomes, make them a solid partner.
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On April 1, 2011, the Dept. of Health and Human Services (DHHS) and Division of Medical Assistance (DMA) issued a Request for Applications (RFA) for expansion of the 1915(b)/(c) Medicaid Waiver. This waiver allows Local Management Entities (LMEs) to enter into a 1915(b)/(c) waiver contract with DMA and operate as a Medicaid managed care organization.
Wake County has submitted an application to become a 1915(b)(c) waiver site to manage Medicaid funding of Mental Health, Developmental Disabilities and Substance Abuse services.
What is a Waiver?
The 1915(b)(c) Medicaid Waiver shifts mental health, developmental disabilities and substance abuse services from the traditional Medicaid model into a single capitated funding model using the tools available through a managed system of care. This approach to system management accomplishes the following:
- The Waiver Entity (LME or group of LMEs) assumes the risk in managing services within the Medicaid capitation rate
- Eliminates Medicaid's "any willing provider" provision, allowing the Waiver Entity to limit the provider network as necessary to accomplish access, service delivery and cost containment goals
- Combines authorization and management of Medicaid and state funds at the community level
- Expansion of the successful PBH pilot waiver (currently in Cabarrus, Davidson, Rowan, Stanly and Union counties)
Goals of North Carolina's 1915(b)(c) Medicaid Waiver
The 1915 (b)(c) Medicaid Waiver is focused on the following:
- Improved access to services and quality of care
- Enhance public accountability at state and local level by ensuring services are managed and delivered within a quality management framework
- Increased cost efficiencies
- Predictable Medicaid costs
- Empower consumers and families to shape system through their choice of services and providers
- Maintain a public infrastructure through the Waiver Authority to manage services
- Empower LMEs to build partnerships with consumers, providers and community stakeholders to create a more responsive system of community care
- Serve the "whole person" by enhancing coordination with Primary Care/CCNC
Wake County's Medicaid Waiver Workplan Outline
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