The LME/MCO Voice

NC Council of Community Programs Presentation to

Stakeholder Engagement Group

October 26, 2015

Non-profit organization, incorporated 1983 to assist area MH/DD/SA authorities to improve their services and management

Serves as statewide voice for members through policy and legislative development and analysis, publications, technical assistance, and training and educational activities

NC Council of Community Programs

The NC Council voice is:

• a consensus position that is built through the NC Council internal vetting process

• based on “the greater good” so the position may be a win or lose for any individual LME/MCO

• based on gaps and needs that are trending across the State

• heard in statewide discussions with a general LME/MCO perspective

Alliance Behavioral HealthcareCardinal Innovations Healthcare SolutionsCenterPoint Human ServicesEastpointePartners Behavioral Health ManagementSandhills Center for MH, DD, & SA ServicesSmoky Mountain Center Trillium Health Resources

The Cast of Characters Today (8)

The Map

Local Management Entity is the term used in North Carolina statute (General Statute 122C) for the public agency that locally manages State dollars.

Managed Care Organization is the national umbrella term used often for Medicaid waiver plan managers that are capitated such as the 1915(b)(c) Medicaid waiver.

The terms were fused together to describe the different oversight duties across funding sources.

LME/MCOs are public managers and that continues to mean that all savings are reinvested in the community and services.

Why do we still distinguish between LME and MCO?

Medicaid (DMA)1,453,87794,00 individuals served (monthly average)

Uninsured (DMH)1,437,672 25,00 individuals served (monthly average)

BudgetsTotal State and Medicaid: $3.3bMedicaid: $3bState: $298m

Covered Lives Statewide (as of 6/15)

Outcomes for an Accountable System and No Waiting List

Total State Budget (excluding administration, TBI and DOJ): $298 million

SFY2015-2016 Cut: $110.8 millionSFY2016-2017 Cut: $152.8 million

Cut to Single Stream State Funding

Spend down on the LME/MCO savings from State-funded services and Medicaid services through a statewide rather than local decision

Use savings to fund start-up for Medicaid transformation

Intent of Single Stream State Funding Cut

By the end of SFY16-17, $262 million will have been shifted away from MH/I-DD/SA services.

The LME/MCO savings are one-time funds so the State budget will have a $152.8 million dollar hole in SFY2017-2018.

Calls to question the General Assembly commitment to the public safety net.

Concerns about State Funding Cut:

Outcomes for Accountable System

LME/MCOs continue to manage behavioral health under the 1915(b)(c) waiver for four years after the implementation of a capitated primary health program. Division of Health Benefits (formerly DMA) will

continue to negotiate the PMPM directly with the LME/MCOs for the above time period.

Capitation payments will be made directly to the LME/MCOs by DHB during this time period.

Medicaid Transformation

Physical health includes for-profit managers who are not required to reinvest savings in system.

Medicaid Transformation

Achieving a Better Life Experience ActOutcomes for Asset Development Allows for the establishment of 529 A private

savings accounts to assist individuals with disabilities.

Promotes health and independence.Promotes long-term financial planning. ABLE Program Board of Trustees will be

established.Became effective when it was signed into law

in early August 2015.

Outcomes for Inclusive Living and Integrated Employment Budget extends the foster care age to 21.Budget allocates $7.8 million in SFY2015-2016

which increases to $15.6 million in SFY2016-2017 and recurring thereafter for TCLI consumers.

Budget specifies $2.9 million in one-time dollars are to be used by the Housing Finance Agency to provide incentives to landlords for offering housing units to persons with disabilities.

Autism Health Insurance Coverage will begin in July 2016

Legislative Provisions Related to Consumers’ Lives

Outcomes for Waiting Lists and Accountable Systems

Budget allocates funding for a TBI Medicaid waiver.Foster Care Act calls for a study of feasibility for a

Medicaid waiver focused on children with Serious Emotional Disturbances.

Budget expands funds of NC START to cover children and adolescents with I-DD

Budget increases funding for I-DD residential, day, supported employment and family support services Cross-Area Services Programs (CASPS).

Legislative Provisions Targeting Populations

NC Council Soundbite on State Funding Cut--“Any cut to funding for MH/I-DD/SA services is a cut to PEOPLE and not a business.”

Expanding Your Voice

NC Council would like to partner with stakeholder groups to coordinate

messaging on the State Funding Cut.

Looking for the Unusual Suspects

Please plan to attend the largest annual gathering of MH/I-DD/SU stakeholders at the NC Council’s Conference:

INNOVATE INTEGRATE MOTIVATE December 2ND - 4TH

(Pre-conference December 1st)Pinehurst Resort

For more information, go to www.nc-council.org or call Jean Overstreet at 919-327-1500

Pinehurst Conference 2015