The following analysis is shared by Martha Brock, long-time advocate for better services in our state:

LEGISLATIVE OVERSIGHT and MEDICAID TRANSFORMATION:  Some thoughts to share with you

I have learned some things recently, as I attended the Legislative Oversight Committee on DHHS in December and January and the Medicaid Behavioral Health Subcommittee this past Wednesday, February 28.  I have the advantage of living in the City of Raleigh and being able to more easily meet and talk with (and listen to) legislators that are tasked with making the laws that affect DHHS beneficiaries.

See NC Health News web site and Rose Hoban’s story titled “Behavioral Health Plan Still Needs Refining” published this week.  I was one of three consumer disability advocates who addressed the Subcommittee and commented on The Behavioral Health Plan dated February 1, 2018.

Here some things I have learned.

1. Dave Richard, Deputy Secretary of NC DHHS and leader of NC DMA, has an extremely tough and thankless role to play. The Cooper Administration is meeting resistance fueled both by policy differences and by the partisanship of legislators.  Sometimes it is hard to separate the two motivations so as to be able to come up with proposed compromise.
2. We, as advocates, have to cease clinging to the MCO system now in place—and even to the current Consumer and Family Advisory Committee (CFAC) model. I prefer to discuss the concept of “inclusion” of ALL Stakeholders at all levels of governing:  both local and state.  This means as a new infrastructure is created after the federal authorities approve North Carolina’s plans for Transformation, we will have to urge continued roles for advisory bodies.  These should be modeled on the CFAC statute and to be included in statutes and rules.
3. While the new advisory committees or Boards and Councils may be modeled on CFAC, we may have to advise NC DHHS on a different model or re-named system of advisory bodies for the state and local Managed Care system. These bodies will of necessity reflect the new realities of the newly implemented Medicaid and non-Medicaid delivery of services for DHHS beneficiaries.

Here are some issues for you and your CFAC to consider as Transformation moves quickly forward.

1. What can you do as a CFAC memberor community advocate  as the NC General Assembly addresses Medicaid Transformation?  Who should you talk to as you advocate for improved services?

•       Talk to your own representatives in the legislature in Raleigh while they are at home in your area or by phone.  If you do not know your legislators (in the State Senate and House of Representatives), go to ncleg.net and then to “Who Represents Me” tab.  It is important to look up their contact information and to note which committees they are on.  Look in particular for the DHHS Appropriations Committee members and those on the Legislative Oversight Committees on DHHS and on Medicaid.

2. What are some of the key issues being looked at by the NCGA Committees, particularly the Legislative Oversight Committee (LOC) on DHHS and the LOC on Medicaid and its two disability focused Sub-Committees?

•       First, the single best source of reporting on what is happening in Raleigh is NC Health News edited by Rose Haban(referenced above). There are other reporters including Richard Craver at the Winston-Salem Journal who write on MCO issues, but few who cover legislative activities.  Unfortunately political publications like the ones edited by John Hood or by NC Policy Watch are NOT addressing the important developments, as Transformation is discussed at the NCGA.  Nor are many associations or trade groups including the NC Assn. of County Commissioners.  com and their Capitol reporter, Laura Leslie, sometimes cover these issues.
•       It is important to remember bigger is not always better. We need to continue to support a dual system of Medicaid Managed Care that supports smaller providers as well as the larger ones. How many of you recall CABHAs?  Those entities and the demands the model placed on small groups and solo providers put many out of business.  And, those providers are still gone, as reflected in pressures on workforce availability in NC.

We cannot have a successful model of care in North Carolina in two years, if one is put in place through trial and error.  As the plan Secretary Cohen submitted to the NC Legislature states, we need to learn from NC’s previous errors and from what has worked in other states.  It is essential that the plan put in place also reflects the experience and knowledge of those served by the old county system and the current LME-MCO system, and only through our assertive advocacy will that happen.

3. QUALITY MATTERS.

As Laurie Coker asked at the Sub-Committee meeting Wednesday, “How will quality be measured?”  Will consumers and family input be included NOW in the design stage ahead of full implementation and final federal approval?  Will the quality improvement processes be designed with our input and will measures include consumer and family survey instrument reports?  Will our opinions really matter?

What are your ideas on these or any other issues on Medicaid Transformation and on advocacy on the issues affecting us and our families?  Now is the time to raise these issues and speak up to your legislators and to the leadership of NC DHHS.