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Highlights from “Sustaining Your Business through Medicaid Reform” Provider360° Event

During the Small Business Behavioral Healthcare Week in May of 2018, the Provider 360° team hosted a Medicaid reform summit for behavioral healthcare providers in Kannapolis, N.C. 

To provide some background, the North Carolina General Assembly passed a law in 2015 that directs the entire State Medicaid program to transition from a fee-for-service model to a managed care model by 2019 (Medicaid behavioral health benefits are already utilizing a managed care model through LME/MCOs).

Dave Richard, NC DHHS Deputy Secretary for Medical Assistance, presented on strategies for sustaining your business through forthcoming Medicaid reform changes in North Carolina. Here are four quick highlights from his presentation.

1) The Medicaid Managed Care Proposed Program Design will go live in July 2019. The vision is for these changes is to implement a Medicaid managed care program that:

  • Advances high-value care
  • Improves population health
  • Supports providers
  • Establishes a sustainable program with predictable costs

2) The key themes of the Medicaid Managed Care Program include:

  • Improve health and wellbeing of North Carolinians
  • Focus on the health of the whole person
  • Support clinicians in delivering high-quality care at good value
  • Addresses both medical and non-medical drivers of health

3) There is a plan in place to support Providers through this transition. Some of the supports include:

  • Education and training through regional Provider Support Centers
  • Reduction of administrative burden
  • Assurance of transparent and fair payments to providers
  • Support of workforce initiatives
  • Use of new tools to combat the Opioid crisis
  • Support of tele-health initiative

4) These changes will also include physical and behavioral health integration that will likely include the following: 

  • A single point of accountability for care and outcomes of which will reduce clinical risk and will giv beneficiaries one insurance card.
  • Approximately 1.8 million Medicaid beneficiaries would receive coordinated physical and behavioral health services.
  • Most Medicaid beneficiaries (<90%) would enroll in Standard Plans.
  • A smaller number with significant BH or I/DD needs would be enrolled in Tailored Plans.

This gives a snapshot of what to expect with the upcoming NC Medicaid Reform, however, it is reasonable to expect changes to the proposed program design as the State gets closer to implementation. To follow the progress and find the latest news on NC Medicaid Reform, please visit:

Review the full presentation given by Dave Richard on May 3, 2018:Provider 360 Summit - May 3 2018 - Dave Richard presentation.pdf

About the Author:

Monica Akerele is a native of Charlotte, NC and currently a Graduate Assistant for the Provider 360 collaborative with UNCC and Cardinal Innovations Healthcare. She has over 12 years of business management and supervisory experience gained while working in the Corporate sector. She left the corporate world to pursue her passion of Social Work.

Provider 360° is made possible through a partnership between these dedicated organizations:

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The database of materials to promote business acumen, known as “Provider 360°” was created by the University of North Carolina at Charlotte (“UNCC”) for Cardinal Innovations Healthcare (“Cardinal Innovations”), and Cardinal Innovations will be making the database available to public users through its website.
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