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MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH November 29, 2017 S:\Managers Working Files\BOH\Agenda & Abstracts\2017 Agenda & Abstracts/ November Page 5 fall, which will provide further information around program design, Requests for Information (RFI’s) this winter, which will gather information from experts to flesh out the program design, and Requests for Proposals (RFP’s) in the summer of 2018 to engage providers and candidates for managed care organizations; with the goal of beginning services under the new model in July 2019. Medicaid facts o Medicaid is administered by states, according to federal requirements. The program is funded jointly by states and the federal government. o About 68.5 million people in the U.S. were covered by Medicaid as of July 2017. Two million in NC are insured by Medicaid. About 5.8 million additional children were covered by the Children’s Health Insurance Program (CHIP) as of July 2017. o About 20% of the U.S. population (319 million) are covered by Medicaid/CHIP. One dollar out of every $6 spent in healthcare in the U.S. is Medicaid. Medicaid and CHIP in NC o Medicaid is a health and long-term care coverage program that was enacted in 1965. The Children’s Health Insurance Program (CHIP) was established in 1997 to provide new coverage opportunities for children in families with incomes too high to qualify for Medicaid, but who cannot afford private coverage. o 2,030,268 million people in North Carolina were covered as of July 2017. o Total State Fiscal Year 2016 Medicaid expenditures were $13.9 billion. o State appropriations for Medicaid were $3.5 billion of that $13.9 billion. o Federal dollars make up the majority of the remaining Medicaid budget. o State Medicaid dollars were about 15.7% of the total $22.3 billion state budget. Medicaid Managed Care o Managed care is a health care delivery system organized to manage cost, utilization, and quality. Medicaid managed care provides for the delivery of Medicaid health benefits and additional services through contracted arrangements between State Medicaid agencies and managed care organizations (MCO’s) that accept a set per member per month (capitation) payment for these services. o Over 55 million Medicaid enrollees covered under some form of Medicaid managed care as of July 2014 (77% of total enrollment). o As of July 2011, over 80% of Medicaid beneficiaries in NC were enrolled in some form of managed care. Medicaid Managed Care in the future o Session Law 2015-245 – An act to transform and reorganize North Carolina’s Medicaid and NC Health Choice Programs. Session Law 2016-121 – An act to … Modify certain provisions of the Medicaid transformation legislation. Additional legislation will further define the scope and expectations association with Medicaid managed care. o The intent of the legislation is to expand and connect the majority of remaining Medicaid expenditures to a managed care model that would capitate or limit those expenditures. o The state will issue a request for proposals for 3 statewide commercial managed care organizations and up to 12 regional provider-led entities in 6 regions to manage Medicaid expenses based on a per member per month capitated model. Why does this matter to public health? o Care Management • Role could be removed from health departments (Eliminated or given to MCO’s).