Legislative Oversight Committee on Medicaid and NC Health Choice Update

The Joint Legislative Oversight Committee Meeting on Medicaid and NC Health Choice met on February 28, 2018.

Family Planning Enrollment Update:

Steve Owen, from the Fiscal Research Division provided an update on family planning trends in North Carolina. There has been a consistent increase in the proportion of males enrolled for family planning of over 10% from 2012 to 2017. He also stated the percentage of mothers increased each year from 17.1% in 2012, to 22.3% in o2017. Births that have received a NICU service has increased each year since 2013.

Overview of Medicaid Dashboards:

Steve Owen also provided information on Medicaid dashboards. He informed the committee that children from 0%-133% FPL in the non-Family Planning enrollment changes have decreased since last year. He noted that the Committee should consider reviewing unemployment percentages as drivers of enrollment trends. There are 29 counties that have seen a decline in non-Family Planning enrollment since 6/30/16. View a  map of the counties here.

Medicaid and NC Health Choice Enrollment:

Dave Richard from DHHS presented that enrollment trends are currently below what the expectations of the Department. They are pleased to report that their number was conservative, and will meet their budget expectations.

Medicaid and NC Health Choice Financial Update:

Roger Barnes from DHHS informed the Committee that claims were running about 4.2% below than expectations. They are around $408.8 million under budget for this fiscal year. This number includes the claims and the administrative portions.

1115 Waiver Amendment and Work Plan for Medicaid Transformation:

Fiscal Research Overview:

Steve Owen from the Fiscal Research Division presented on the overview on the new managed care model would be managed through prepaid health plans.

Both commercial plans and provider led plans would be considered. There would be 3 statewide contracts and up to 12 regional contracts. All populations of Medicaid would be covered except for duel eligibles, medically needy, presumptive eligibles, HIPP enrollees, and emergency only recipients. All services would be covered except dental, and services prior to eligibility of fabrication of eyeglasses. The Department was directed to ensure eligibility.

There are some inconsistencies with the law that have been amended. The amended waiver application only includes projected budget impact for federal spending. He stated that the only way to estimate the maximum potential impact is to derive the nonfederal share using exhibits in the waiver. He asked the Committee to consider the implication for federal funding if CMS approved the waiver as filed and DHHS is never authorized by the General Assembly to implement elements included in the waiver.

HHS Overview:

Christen Young from DHHS provided an overview of the state tools for modifying the Medicaid program.  She states that there are three primary tool for modifying a state Medicaid program that include the following:

  • State Plan Amendments (SPA): These amendments change the administrative aspects of a state’s Medicaid program live covered benefits and provider payments.
  • 1915 Waivers: These are used in particular ways for single actions.
  • 1115 Waivers: These are used for broad sweeping Medicaid project. It allows state to violate a portion of the federal Medicaid statute, and is granted for a 5 year term.

She stated that some of the components of the waiver will require additional legislative authority to implement. This is made clear in the submission to CMS.

DHHS has been meeting weekly with CMS subject matter experts since September to discuss waiver components.

The next meeting is planned for March 13, 2018.


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