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7 <br />Medicaid waivers are used to improve access to and quality of services <br />and manage cost. Entities that operate waivers are generally referred to <br />as Managed Care Organizations (MCO). NC has chosen to operate its <br />waiver through a single prepaid inpatient health plan (PIHP). PIHPs are <br />managed care organizations that provide, arrange for or otherwise have <br />the responsibility for the provision of specialty care (including inpatient <br />and institutional) for individuals with MH/DD/SAS needs. PBH currently <br />operates a PIHP and is the only combined 1915(b) (c) waiver in North <br />Carolina. North Carolina has obtained approval from the Centers for <br />Medicare and Medicaid Services (CMS) to transition the entire state to a <br />combined 1915 (b) (c) waiver replicating the PBH model statewide. <br />For more information about waivers, please see the waiver section on the <br />OPC website, www.ogcareaprogram.com <br />6. What does OPC think about managed care? <br />We think it is the right thing to do. <br />OPC supports the concept of managing care to assure that all individuals <br />receive appropriate services, and we strongly support the concept of <br />public management of the behavioral healthcare system. <br />7. Why are some groups opposing the waiver? <br />Some people are worried about what this change will mean for providers <br />and consumers. <br />Expanding the waiver statewide is a big change for North Carolina, and <br />as with any change of this magnitude, there is some anxiety about what it <br />all means. Some advocacy groups, particularly those representing the <br />interests of individuals with I/DD, have been very vocal about their <br />concerns for that population in a waiver environment. While it is true that <br />care for these individuals (as well as individuals with mental health and <br />substance use disorders) will be managed differently in the future, PBH, as <br />well as other states, have successfully operated waivers that appropriately <br />serve all disabilities. An article by the National Leadership Consortium on <br />Developmental Disabilities that looked at the experiences of four states <br />concludes... <br />Smith and Ashbaugh, in a groundbreaking 1995 analysis of <br />potential applications of managed care within the developmental <br />disabilities services sector, wrote: "Whatever mistrust there might be <br />about managed care has to be balanced against its trinity of <br />promises: -ower costs, better access, and higher quality. Curbing <br />Medicaid payments to the states means developmental disabilities <br />systems will face a far different fiscal landscape in the foreseeable <br />