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Questionnaire NameNorth Carolina Amended 1115 Demonstration Application
DescriptionNorth Carolina is amending their 5-year section 1115 demonstration application previously submitted on June 1, 2016. The amended application requests to implement managed care transformation for Medicaid beneficiaries including incorporating tailored plans for some populations. Additional proposed programs under the amended application include the development of a substance use disorder program, expansion of the provider loan repayment program, building a behavioral health home care program, and piloting new programs such as telemedicine and regional resource management for unmet needs. The federal comment period will be open from December 5, 2017 through January 5, 2018.
Response FromID: #312433 on Jan 5th 2018 10:35 pm
North Carolina Amended 1115 Demonstration Application

North Carolina Amended 1115 Demonstration Application

We encourage the public to submit their comments on as they relate to demonstrations open for public comments. In support of transparency and open government, all public comments received are immediately posted and are in the public domain. Center for Medicaid and CHIP Services staff will review all public comments posted and we reserve the discretion to delete comments that are generally understood as any of the following: obscene, profane, threatening, or otherwise inappropriate.

Refer to the Application

Open for Public Comment – 12/05/17 – 01/05/18

Please provide your comments here and/or attach below:

January 5, 2018

Dear Secretary Hargan:

I am the parent of a medically fragile child in North Carolina and I have concerns that the move to managed care would not address the needs of children like mine. We have learned that children with complex medical needs as a rule do not follow any template and must be supported on an individualized basis.

I agree with my friends at Advocates for Medically Fragile Kids NC:

“We are deeply concerned about moving Medicaid in North Carolina from a fee-for-service model to managed care. It would reduce and complicate overall access to healthcare, add administrative burden for providers, and has not been shown in any major study to reduce costs. Moving Medicaid to managed care in NC is especially concerning with the issues surrounding unscrupulous actions of one of our current LME/MCOs (Cardinal Innovations). An uncertain future at the federal level regarding the ACA, Medicaid, and CHIP makes the move to managed care even more worrisome. Any changes to these programs will significantly impact NC and its ability to ensure the well-being of its citizens.”

Please reconsider the move to managed care and certainly exclude persons enrolled in CAP/C, CAP/DA and TBI waivers. Please also advocate for deeper stakeholder collaboration in the systems.

I am particularly concerned about a system that would trap us into regions for receiving care. Our children’s diagnoses are so rare that we are lucky if their is an accessible specialist in the country, much less Raleigh. We need support to see the doctors who fit our needs regardless of geography.

As parents of Medically Fragile children, we save the state money. It would be exponentially more expensive to house our children in a hospital or institution. Of course, we also want our son to live with us. In order to do that safely, we create hospital-like settings and coordinate with multiple agencies and service-providers. It’s a difficult job that we do on top of our paid jobs, on top of our parenting, on top of our own pursuits and obligations. We are happy to do this for our children, but we certainly don’t need it to be more difficult.

Thank you for your consideration of our comments. We are happy to discuss further

Natalie Hart
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