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NC Department of Health and Human Services

"We have an obligation – an obligation we have willingly accepted as a state – to help those in need. And we must, at the same time, be good stewards of taxpayer resources. We believe this Medicaid reform plan is responsive to both those obligations.”

- DHHS Secretary Aldona Z. Wos, M.D., March 17, 2014

N.C. Medicaid Reform Plan

The DHHS N.C. Medicaid reform plan was submitted to the General Assembly March 17, 2014. (Click here for a PDF of the reform plan.) The plan is based on input from two prior Medicaid Reform Advisory Group meetings, and from traveling to meet with stakeholders across the state. Below is a high-level overview of the five recommendations to create a Medicaid system that rewards healthy outcomes (click here for details).

  • Physical health
    • Recommendation 1: North Carolina Medicaid services for physical health will be coordinated through accountable care organizations (ACOs) that share savings and losses with the state and are responsible for equity.
    • Recommendation 2: ACOs’ coverage of the population and financial accountability will rise progressively; DHHS will benchmark progress.

  • Mental health, intellectual/developmental disabilities and substance abuse services
    • Recommendation 3: Enhance the state’s Medicaid mental health, intellectual/developmental disability and substance abuse service delivery system.
  • Long-term services and supports (LTSS)
    • Recommendation 4: Streamline and strengthen case management for long-term services and supports.
    • Recommendation 5: Shape the ultimate direction of LTSS.

Next steps: DHHS will continue to listen and collaborate with stakeholders to refine the proposal and present it to the General Assembly in March.

Partnership for a Healthy North Carolina

Since its inception in 1970, the N.C. Medicaid program has evolved into an essential part of the state’s health care system. It currently serves approximately 1.8 million low-income parents, children, seniors and people with disabilities. It also is a significant financial investment for taxpayers, holder $13.5 billion, or about 75 percent, of the total DHHS budget.

Medicaid reform has three objectives mandated by the legislature:

  • Create a predictable and sustainable Medicaid program for N.C. taxpayers.
  • Provide care for the whole person by uniting physical and behavioral health care.
  • Increase administrative ease and efficiency for N.C. Medicaid providers.

Medicaid Reform Advisory Group

The Medicaid Reform Advisory Group was instructed by the General Assembly to obtain broad stakeholder input in a public forum and ensure transparency in the proposal development process. Advisory Group input was used by DHHS to develop the best reform plan for North Carolina. The Advisory Group had three citizens appointed by Governor McCrory and two members of the N.C. legislature.

Advisory Group Members

Advisory Group Meeting #3: February 26, 2014

Advisory Group Meeting #2: January 15, 2014

Advisory Group Meeting #1: December 5, 2013


Medicaid Reform Videos

  Integrated Care Policy Summit 4/3/2014: DHHS Secretary Aldona Wos, M.D. (12:30) Medicaid Reform Advisory Group 2/26 Meeting: DHHS Secretary Aldona Wos, M.D. (5:22) Medicaid Reform Advisory Group 2/26 Meeting: DHHS Deputy Secretary Robin Cummings, M.D. (6:14) Medicaid Reform Advisory Group 2/26 Meeting: Chair Dennis Barry (4:28) Medicaid Reform Advisory Group 1/15 Meeting: DHHS Secretary Aldona Wos, M.D.(4:42) Medicaid Reform Advisory Group 1/15 Meeting: Chair Dennis Barry (7:01) Putting People First: "The Partnership for a Healthy North Carolina" (1:52)


Shaping Our Future: Long-term Services and Supports Strategic Planning

"Shaping Our Future" is an initiative where DHHS and the LTSS community collaboratively develop a proposed design for future Medicaid-funded LTSS services. Goals and other details are listed in Appendix 3 of the Medicaid reform plan.

The strategic planning efforts are led by two workgroups of community stakeholders and DHHS staff:

  • Long-term Care Workgroup (May 2014 – Jan. 2015); for example, skilled nursing facility services and Community Alternatives Programs.
  • Intermittent Services Workgroup (July 2014 – Jan. 2015); for example, home health and hospice.

Please see the LTSS Strategic Initiative Timeline for an overview.

Shaping Our Future Meetings & Materials

Long-term Care Workgroup

Intermittent Services Workgroup

  • Stakeholders List (coming mid-July)
  • July 23 Kick-off Meeting
    • Agenda (coming mid-July)
    • Presentation (coming end of July) Ready NC Connect NC