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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: #312441 on Jan 5th 2018 10:54 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:

I am the parent of a medically fragile child on the CAP/C waiver. She has primary private insurance with Medicaid secondary. Having to navigate networks for both our private insurance and a Medicaid PHP/MCO would limit the ability to fully use private insurance benefits should her providers not be in-network for both. Worse would be that she might not be able to access the care she needs when she needs it. Having to jump through unnecessary hoops would delay treatment, which could literally cost her her life. She takes over a dozen medically necessary prescription drugs each day, many of which have to be compounded at a specialty pharmacy. It is unclear to me in the waiver application how access to prescriptions would be handled, but if controlled by PHP/MCOs, access would likely be limited, just as it will be to providers. Because she has a rare disease, the ability to go outside of our possible PHP/MCO geographical catchment area to access appropriately skilled providers is needed. Denying her quick access to members of her care team could be fatal. I've seen the reports of the crises that are occurring in other states who've moved Medicaid to managed care. Why is NC doing this to us, especially when one of the LME/MCOs here (Cardinal Innovations) has already shown us all just what a bad idea managed care is? It does not save money (look how much Cardinal misused!), especially in providing care for people with medically complex needs, and it most definitely does not improve care...just talk with impacted consumers and their families for a change instead of legislators or even DHHS staff. To see, read, and hear real life examples of the devastation that comes with managed care, visit this website to see what's happening in Texas: Managed care has proven to be bad for NC in the past, and it is bad for NC in the future. I strongly oppose NC moving Medicaid to managed care. Medicaid as fee-for-service in NC works & is cost-effective too. As the saying goes, "If it ain't broke, don't fix it until it is." If they do it, however, CAP/C, CAP/DA, and the TBI waivers must be excluded. Additionally, I support full Medicaid expansion in NC and do not support work requirements or premiums. Also, the state already does a poor job of fully engaging beneficiaries and families in a manner that would allow us to best inform them for policy-making & program improvement purposes. Managed care would make that worse.
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