By Ciara Zachary

Seventy percent of the people enrolled in Medicaid and NC Health Choice in North Carolina are children. So as the state’s Medicaid transformation process continues to meet major milestones, NC Child is closely monitoring this complex undertaking for its impacts on children. Here’s a brief update on where we are in the process:

• On October 24, the state received formal federal approval to shift the current fee-for-service Medicaid model in NC to managed care.
• Eight companies submitted RFP bids by October 31, hoping to win those managed care contracts.
• We expect the NC Department of Health & Human Services to award contracts by February 2019.

As the Department moves forward and evaluates the bids, here are three key priorities we’re focused on to ensure that children and families get the care they need:

Beneficiary engagement

Shifting to managed care means that parents, caregivers, and families will have to learn a new system to navigate. Parents need to make sure that their children will still receive quality primary and specialist care for healthy growth and development. The RFP requires plans to establish committees to hear from members, but there is no mention of how the Department plans to engage beneficiaries – especially parents and caregivers – to understand whether & how transformation is meeting their children’s needs.

As we continue our advocacy for children and families, NC Child is launching a Parent Advisory and Advocacy Council. We are working with parents and caregivers to developed shared advocacy priorities and strategies to make sure that children’s needs are met as transformation implementation continues.

Children’s Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Medicaid benefit

We are encouraged that the Department included clear language on EPSDT. EPSDT is a federally-mandated benefit that guarantees that children get the right care at the right time for all medically necessary services. Moving forward in the transformation process, we will track how plans prioritize children’s access to services required by the EPSDT benefit. Further, NC Child wants to make sure parents and caregivers understand EPSDT, and how important it is to children’s growth and development.

Care management, especially for pregnant women and children with special health care needs

As with EPSDT, NC Child appreciates the Department’s language in the RFP that pays special attention to care management. Care management is important for many children and pregnant women because they have complex health needs that are better managed by coordinated care and not a simple doctor visit. CC4C and Pregnancy Medical Home for pregnant women have been successful programs that improve health outcomes for moms and babies. As Medicaid managed care begins next fall, we want to see these services continuing to improve.

There are many moving parts to Medicaid transformation, and many more milestones to meet over the next year. NC Child will continue to track information from the Department, the federal Center for Medicare and Medicaid Services (CMS), and potential managed care plans to understand how transformation impacts children and families – and whether their concerns are being met. Watch for our next update once the Department awards those contracts in February 2019.

Ciara Zachary is Health Program Director at NC Child.