CMS Approves North Carolina’s Medicaid Waiver Request

The Centers for Medicare and Medicaid Services (CMS) today approved North Carolina’s request to implement the transition to Medicaid managed care and integrate physical health, behavioral health and pharmacy benefits. The North Carolina Department of Health and Human Services (NCDHHS) submitted its amended 1115 Demonstration Waiver application in 2017.

“The waiver approval represents an important milestone in the transformation of Medicaid from a fee-for-service program to one that puts greater emphasis on population health and medical science. The focus on social determinants of health are essential to the success of the program,” said North Carolina Medical Society (NCMS) CEO Robert W. Seligson. “These changes can be beneficial to Medicaid recipients and the health care system as a whole.”

This transition toward whole person care includes the authority to create Tailored Plans to serve people with intellectual/developmental disabilities (I/DD) or higher intensity behavioral health needs and a specialized behavioral health home model to ensure strong care management for those individuals. To support broader state efforts to combat the opioid crisis and improve access to treatment, DHHS received authority to implement new flexibilities that allow for treatment of substance use disorder in institutions of mental disease (IMD).

“Our highest priority is the health and well-being of the people we serve,” said DHHS Secretary Mandy Cohen, M.D. “Receiving this waiver approval from the federal government will help us continue to build an innovative and whole-person centered system that addresses both medical and non-medical drivers of health.”

In 2015, the General Assembly directed the transition of Medicaid from a predominantly fee-for-service structure to managed care. Since then, DHHS has solicited extensive feedback from clinicians, beneficiaries, hospitals, counties, health plans, elected officials, advocates and other stakeholders in developing the components of the 1115 Waiver Demonstration. The approved waiver focuses only on the aspects of North Carolina’s Medicaid managed care transformation that require CMS approval.

For further details on the waiver and the state’s Medicaid transformation visit the NCDHHS website.


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