Minutes 05-02-2019 Regular Meeting

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19 At the April 2, 2019 regular Board meeting, a petition was made requesting that the County communicate Orange County's preference to be part of a Tailored Plan region that also includes Durham and Wake counties. Staff has attached draft language for a proposed letter addressing that interest. The Board voted on April 16th but it was a tied vote and thus failed. Thus, Commissioner Dorosin requested that this be re-visited. It is proposed that the Board formally authorize the Chair, on behalf of the Board, to sign a letter expressing the County's preference, and for the Clerk to the Board to submit the letter as soon as possible. Commissioner Bedford apologized that she was unable to attend the April 16th meeting due to being with her sister who had open-heart surgery. She said she does have an adult daughter with developmental disabilities, who is served by Cardinal Innovations (CI) and currently resides in Harnett County. Commissioner Bedford said counties have been asked to provide input about the regrouping for tailored plans. She said tailored plans are in part 2 of the Medicaid expansion. She said this decision will not be made by the MCO grouping, but rather the state DHHS will make the final decision, and requested input from the NCACC and the counties. She said the LME/MCOs will have representatives to this process as well. Commissioner Bedford said as someone who is very familiar with the process, it would be easier and more accessible for the residents in Orange County to access services in Orange County and be aligned with Wake and Durham counties, as opposed to the 20 counties heading west, with a headquarters in Charlotte. Commissioner Bedford referred to the Cl CEO's comment that more money was spent than appropriated, and said this is expected from most of the counties in the state, because the MCOs had been accumulating fund balance. She said in 2017, the General Assembly (GA) appropriations limited and decreased their funding for those who are uninsured or underinsured, and required maintenance of expenditures at the 2014-2015 level. She said the GA wants the MCOs to spend more than they are appropriated in order to spend down the fund balance. Commissioner Bedford said on March 271h the News & Observer wrote an article reporting that the State Auditor Beth Wood had again found that there are hundreds of millions of dollars being held by these MCOs, in excess of the recommended 2% fund balance. Commissioner Bedford said today Cl responded with actual numbers of the $4 million community outreach done by Cl. She said it was expressed that Orange County is the largest county in this region, but the rates are set by actuaries and are based on a complex formula. She said, even as a CPA, these documents can be hard to follow. She said she has provided the Board with CI's list of eligible members, starting with Mecklenburg County at over 1 million. She said Orange County falls in the middle, but this is irrelevant, as the County will be funded based on the formula on a per person basis. Commissioner Bedford referred to the issue of funding Club Nova, who came to the Board with the news of this $500,000 funding promise made by Cl, but that this promise was contingent upon Club Nova raising 80% of it $4.5 million goal by year's end. She said this goal is lofty, if not unattainable. Commissioner Bedford said there is language that states, "LME/MCOs shall be prohibited from offering, and counties will be prohibited from receiving any financial or material inducement to change or maintain current affiliation," and so these funds to Club Nova should not be a factor in the Board's decision.