North Carolina
Providers key in NC’s push to launch delayed Medicaid plans for complex populations
After multiple delays, the North Carolina Department of Health and Human Services says it’s “on track” to implement specialized Medicaid plans this summer that are designed for beneficiaries with complex needs.
Now scheduled to launch on July 1, the so-called “tailored plans” are expected to cover about 150,000 existing Medicaid participants who require more extensive care and support than typical enrollees. Many people with intellectual or developmental disabilities, traumatic brain injuries, complex psychiatric disorders and substance use disorders will be moved to the plans, according to DHHS.
Unlike standard Medicaid plans, the tailored plans will be administered by a network of four state-funded behavioral health organizations, or LME-MCOs. For the past decade, these regional managed care organizations have been providing access to behavioral health services for people with complex needs across the state, sometimes operating under a cloud of controversy.
Now, they have been tasked with connecting tailored plan participants to physical and mental health care providers.
The tailored plans were initially scheduled to go live in December 2022, but DHHS delayed the launch to give the LME-MCOs more time to prepare. Additional delays were announced last year, with the department citing a lack of buy-in among some providers.
Jay Ludlam, the state’s deputy secretary for Medicaid, gave lawmakers an update on the plans’ status as part of Tuesday’s meeting of the Joint Legislative Oversight Committee on Medicaid. The LME-MCOs, he said, have “made significant progress in closing any remaining gaps in their networks.”
Push for more providers
Ludlam told the committee that DHHS established an internal “disruption standard” after the most recent delay. The department’s goal was to ensure that at least 80 % of tailored plan participants would “not be disrupted in their current relationships” with providers.
“Our focus has been on those families that […] have worked with certain care teams for years, often since birth, to provide care to their loved ones,” Ludlam said. “We also saw pressures from others who wanted, as much as possible, to ensure that we as a department recognize that it’s not only just the provision of services, [but] also who’s providing those services … that is important to those families.”
He said that federal regulators were OK with the 80% goal last spring, but they want at least 90% of the state’s tailored plan participants to have the option of staying with their current provider in order for the plans to launch this July.
That rankled committee member Sen. Ralph Hise (R-Spruce Pine), even though he’s long been critical of the LME-MCOs.
Hise said he was concerned that the higher standard required by the Centers for Medicare and Medicaid Services would force the LME-MCOs to “sign contracts that might not be in the best interest of their system.” Some providers, he said, were already dissatisfied with the reimbursement rates that the LME-MCOs were offering for services.
“Then CMS kind of steps in and says, ‘First of all, you have to have 80 [%] and now you have to have 90 [%],’ and suddenly these contracts are getting signed,” Hise said. “I mean, somebody stuck their nose in a contract dispute, told them who they had to sign with and, in effect, what rates they had to sign for.”
Ludlam responded by pointing out that the issues with provider contracting “are sometimes not about money.”
“They’re about how many lives the tailored plans were managing, and that it wasn’t sufficient for the systems to basically bother to pick up the pen and sign those contracts,” he said. “By focusing on what the members need, and of course monitoring the potential impact on rates, I do believe that we will not only protect people through this process, but that we will be able to get to go live on July 1.”
One factor in creating a Medicaid plan is the quest for “network adequacy” — the ability for a patient to find the care they want and need close to home. This means the plans’ managers have to contract with hundreds, sometimes thousands of health care providers throughout a region.
Ludlam noted that two of the state’s LME-MCOs recently contracted with a “large system” to accept tailored plans. Ludlam declined to share the system’s name, but Charlotte-based Atrium Health had previously been identified as a significant holdout in the state’s push to enlist providers. A spokesperson for Atrium did not immediately respond to email from NC Health News on Wednesday.
Ludlam said DHHS has not “re-measured” the potential disruption of existing patient-provider relationships since the unnamed system came aboard.
“If I were to highlight any potential risk to go live, it is whether or not the tailored plans will be able to close out some of those other contracts that are going to be necessary to minimize the disruption for consumers and members,” Ludlam said.
He added that DHHS will make a “go or no-go decision” in April on the July 1 rollout date if the LME-MCOs have not contracted enough providers to satisfy CMS’ requirement by then.
“If we really saw a high risk of potential member harm for individuals, we would do what is necessary to protect people,” Ludlam said of the possibility of another delay. “We would want to work very closely with CMS to make sure that if they’re declaring that we’re unable to go live, that they’re doing it based on the best available data and for all the right reasons.”
Rollout riding on LME-MCOs
Ludlam said the burden of contracting enough providers to maintain continuity of care for tailored plan patients will largely fall on the LME-MCOs. They know the “individuals who might be at risk” and “where they are,” he said.
“The work is going to be on them,” he said. “I think generally they are very close to getting contracts with these care teams, and we will continue to monitor it over the next couple of months.”
The implementation of tailored plans will follow a consolidation that left the state with four LME-MCOs instead of its previous six. Sec. Kody Kinsley, head of DHHS, ordered the consolidation in November to streamline the plans’ rollout.
Trillium Health Resources took control of Eastpointe Human Services under the consolidation, creating a single organization to serve 46 counties across eastern North Carolina. Another LME-MCO, the Sandhills Center, was dissolved in connection with the consolidation.
The remaining organizations include Vaya Health, which serves most of the western part of the state, and Alliance Health and Partners Health Management, which together cover a mosaic of counties in central North Carolina.
Ludlam said his “Day One goals” for tailored plans are to “make sure that members have cards in hand, that the health plans have sufficient networks, that providers can get paid and that members can have access to those health plans in order to understand their benefit, understand who they’ve been assigned to and make sure that they can get care.”
This article first appeared on North Carolina Health News and is republished here under a Creative Commons license.
North Carolina
Greenville Police Department Join Effort Promoting Safe Firearm Storage
The Greenville Police Department joined community leaders in Pitt County this week to promote safe firearm storage as part of North Carolina’s annual NC S.A.F.E. Week of Action, the Greenville Police Department said.
In a statement, the Greenville Police Department thanked NC S.A.F.E. and the North Carolina Department of Public Safety for the opportunity to help educate residents about responsible firearm storage practices.
We want to thank NC S.A.F.E. and the North Carolina Department of Public Safety for allowing us to help relay to the community the importance of safely securing firearms so that we can avoid tragedies in the future!
The local event follows Gov. Josh Stein’s proclamation recognizing June 1-7 as NC S.A.F.E. Week of Action.
According to Gov. Stein’s office, the campaign aims to encourage gun owners to securely store firearms and make safety resources more widely available across North Carolina.
An unlocked gun is a tragedy waiting to happen, and too often, it does,” said Governor Josh Stein. “NC S.A.F.E Week is a reminder to all of us about the measures we can all take to keep ourselves and the people we love safe.
Safe firearm storage is one of the simplest steps we can take to prevent tragedies before they happen,” said North Carolina Department of Public Safety Deputy Secretary William Lassiter Lassiter. “NC S.A.F.E. is increasing awareness around secure firearm storage and making safety resources more accessible to help reduce preventable injuries and build safer communities throughout our state.
North Carolina
The Real Reason North Carolina’s GOP Is Proposing the Most Radical Anti-Abortion Bill Yet
Another anti-abortion abolitionist proposal has been in the news. This time, conservative lawmakers in North Carolina have asked voters to approve a state constitutional amendment recognizing the personhood of embryos and establishing that anyone who ends an embryonic life is guilty of first-degree murder. Those penalties might also apply to people pursuing in vitro fertilization or using some contraceptives, given that abortion foes sometimes view either as requiring the taking of unborn life. And that’s the most ordinary part of the proposal: The bill also provides that private individuals have a right to use deadly force to prevent “the willful destruction of life.” House Bill 1232 isn’t clear about exactly who could exercise this constitutional right to vigilante violence. Would it just be available to those seeking to kill abortion providers and patients? Or might it apply even more broadly to those seen to aid them?
The bill has been greeted with bafflement and disbelief. One of its co-sponsors was embarrassed enough to remove his name from the proposal. But the idea of licensing private violence did not come out of thin air. There have been decades of debate about the use of force within the anti-abortion movement. And as conservatives embrace an increasingly punitive agenda, old justifications for violence have reemerged.
Since the 1960s, abortion foes have rallied around the idea that constitutional rights begin the moment an egg is fertilized. That meant that liberal abortion laws would violate the federal Constitution. Because that claim didn’t gain traction in the federal courts, abortion opponents didn’t have to settle what it would mean in practice to enforce this idea of personhood. Did it require that abortion be punished as murder, or that women be punished? Might it instead require more support for women during pregnancy?
By the 1980s, as the anti-abortion movement aligned with the Republican Party, the movement’s leaders increasingly retooled their ideas of justice for the unborn to fit the GOP’s tough-on-crime agenda. They endorsed fetal homicide laws and backed prosecutions based on conduct during pregnancy. But these moves didn’t lead to the reversal of Roe, much less a decline in the abortion rate.
Frustration led to a wave of lawbreaking. Operation Rescue, a clinic blockade group, invited supporters to use civil disobedience and break the law if necessary to stop people from entering abortion clinics. Operation Rescue disrupted the Democratic National Convention in 1992 and recorded thousands of arrests. Blockaders even developed a legal argument to justify their actions, drawing on the common law defense of necessity, which allows someone to break a law to achieve a greater moral good.
Some advocates went further. If abortion really were the murder of an equal person, they asked, why wasn’t it justified to use deadly force to protect that equal person?
Prominent figures in the late 1980s and early 1990s elaborated on that argument in books and talk-show appearances. The claim justified kidnappings, firebombings, and a series of murders of doctors, clinic staff, and security. Powerful anti-abortion groups denounced the violence, but the question of deadly force struck others as surprisingly complex. If a fertilized egg was an equal person, and if the way to protect that person involved violence, why was deadly force off limits?
While violence against abortion clinics and providers never went away, it receded from the peak of the 1980s and early 1990s. The federal Freedom of Access to Clinic Entrances Act, which heightened penalties for threats, violence, and obstruction of people entering facilities, radically undercut the clinic blockade movement when Congress passed it in 1994. So did the conviction of high-profile murder defendants like Michael Griffin and Paul Hill. The clinic blockade movement was consumed by internal divides, with multiple organizations even claiming the name Operation Rescue. Anti-abortion leaders mostly focused on change through the courts and politics.
Now that Roe is gone, the movement is at an inflection point. Personhood has become the movement’s new North Star. And while success in the federal courts isn’t imminent, there is now no reason a state couldn’t enforce any vision of personhood. That means that conservatives have to decide what they mean by enforcing the rights of the unborn. This bill is a sign that even punishing women doesn’t strike some as harsh enough.
This bill won’t pass. For starters, North Carolina is not the most likely state to pass any abortion abolitionist bill; at the moment, it doesn’t even ban abortion from the moment of fertilization. And no state has yet passed any kind of abolitionist proposal, much less one allowing people to gun one another down in the name of protecting life.
But this bill has a different resonance now that Donald Trump has pledged not to enforce the FACE Act in the abortion context except in the most extreme circumstances. It is also a reminder of how the Overton window on personhood is shifting. Abolitionists who call for the punishment of women are gaining influence in state legislatures and movement debates. They have developed their own incremental approach: In South Carolina, for example, Richard Cash, a powerful lawmaker, tried this session to advance a bill punishing women for abortion, but only for a misdemeanor, rather than a felony. The bill became the second abolitionist proposal to pass through a committee this spring before time ran out to pass it this session.
Leading anti-abortion groups still speak out against abolitionists, but their strategy is clear: normalizing the idea of punishing women. The more extreme proposals conservatives advance, the more previously unthinkable ideas become politically realistic.
North Carolina
In North Carolina Senate race, Democrat leans on economic message early
With one exception, Democrats have lost every single U.S. Senate race in North Carolina this century, their quests in recent years rocked by controversy and difficult political climates. This year, they are betting two things will make it different: The candidate is Roy Cooper, the southern state’s former governor, and the economy, where voter anger could imperil the party in power.
Months out from Election Day, Cooper’s Senate campaign is centering his message on economic anxiety. In his first television ad of the cycle — details of which were first reported by MS NOW — Cooper weaves his personal story with the kitchen-table concerns preoccupying voters.
“I’m running for the Senate to make life easier today,” Cooper says in the spot, which his campaign says is part of a seven-figure ad buy. “To go after insurance companies ripping you off. To make sure you can retire with dignity. And to build an economy that finally values working people.”
The North Carolina race is primed to be one of the most important contests of this fall’s midterms as he attempts to flip control of one of North Carolina’s U.S. Senate seats for the first time since 2008. The recruitment of Cooper — a two-term governor who was elected both times while Trump carried the state in the same election cycle — has buoyed the party’s hopes.
This is also a contest in which Trump’s influence is clearly a factor. The president has thrown his support behind former Republican National Committee Chair Michael Whatley, pitting a candidate with deep ties to Trump against Cooper, who has long demonstrated an ability to win in the state despite national political headwinds.
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