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Policy Changes & Neonate Care:

Medicaid Reform, Federal Legislation,Current State Bills

Elizabeth Hudgins, Executive Director
NC Pediatric Society
March 25, 2019

u I am employee of the NC Pediatric Society

u I have no conflicts to report

NC Pediatric Society

u Mission: To empower pediatricians and our partners to foster the

physical, social, and emotional well-being of infants, children,
adolescents and young adults.
u About 2,300 members statewide
u Duke, ECU and UNC are academic partners
u Key activities include advocacy, CME, and special projects – Fostering Health
Learning Objectives

u Understanding of some of the implications of Medicaid reform on child health,

including for newborns
u Understanding of key proposed legislative policies that may affect child

Apt Parenting
Two key facts for understanding
Medicaid reform and kids

u70% of all people covered by

Medicaid and CHIP are kids

uMorethan half of all births are to Clipart Library

mothers covered by Medicaid

Medicaid Reform
u 2015 – legislation passed to begin move to Medicaid managed care for most
u Initially just physical health
u Changed to include more MH services
u Waiver for managed care approved and request for bid issued
u Certain population are not included in initial roll-out
u Certain services are carved out
u Dental
u Mental/behavioral health services – but just temporarily
u Plans awarded – February 2019
u Contracting period – now
u Full state implementation February 2020
u 2 pilot areas will start November 2019 (Regions 2 and 4)
Awarded Plans

u AmeriHealth Caritas North Carolina, Inc.
u Blue Cross and Blue Shield of North Carolina
u UnitedHealthcare of North Carolina, Inc.
u WellCare of North Carolina, Inc

u Carolina Complete Health (Regions 3 and 5)
Performance Improvement Project (PIP)

u Plans must have at least 3 Performance Improvement Projects (PIPS) as part

of their quality work
u One non-clinical aligned with quality strategy
u Two must be on a handful (7) of specified topics
u Pregnancy intendedness
u Tobacco cessation
u Diabetes prevention
u Birth outcomes
u Early childhood health and development
u Hypertension
u Behavioral health integration
Quality Metrics – 48 Overall

u WITHHOLD is the strongest level – 9

u Child focused ones include

u Asthma medication
u F/u after hospitalization for MI
u Prenatal and postpartum care
u Alcohol and other drug dep. treatment
u Tobacco cessation
u Well-child visits in the 3,4, 5 and 6th years of life
Quality Metrics – Priority Measures (26)

u Getting Care Quickly

u Getting Needed Care
u Coordination of care (child specific)
u Patient satisfaction (variety of measures)
u Child weight
u Preventive dental
u Combo 10 at age 2
u HPV (2), mening, Tdap at age 13
u Acute care usage
Standard Plans and Tailored Plans

u Standard Plan – medical home is keyed to physical health needs and other
MH/BH services may be provided as needed

u Tailored Plan – medical home is keyed to MH/BH health needs and physical
health services may be provided as needed
u Contracts awarded May 2020 (tentative)
u Launch – July 2021

u Will also keep FFS for phased-in populations and some other groups
Child Aged 0-3 with or at-risk for
Developmental Delay or Disability
Key success elements we will monitor

u Vulnerable population (newborns, foster kids and grads, rural, etc.)

u Benefit package – EPSDT/Bright Futures
u Network adequacy
u Administrative ease
u Provider reimbursement
u Trends
u Development of Tailored Plans
On-going advocacy of NCPeds for
Medicaid Reform
u Regular meetings with NC Medicaid
u Pediatric representation on key committees
u Meeting and working with Plans on strong measures for kids
u Specifically designed webinar for Plans on EPSDT
u Monitoring legislative changes
u Working to combine CHIP into Medicaid
u Surveying for baseline data
u Seeking survey partners for PA and newborn access to care
Moving on to legislation…

Legislation – Federal

u CARA/Plan of Safe Care (Comprehensive Addiction and Recovery Act)

u Providers need to notify CC4C when newborns affected by prenatal substance exposure
(legal or illegal)
u SEPARATE from a report of child abuse or neglect
u Learn more:

u Families First
u Passed February 2018
u Allows more IV-E funding prevention of child abuse and neglect
u Substance abuse disorder treatment
u Mental health services
u In-home parenting supports
NC General Assembly

u About 700 bills filed so far

u ~ 375 bills filed in House- ~290 bills filed in Senate (as of 3/18)
u Key dates
u April 2 – most bills, including approps, need to be filed in Senate
u April 16 – most bills need to be filed in House
u April 23 – approps bills need to be filed in House
u May 9 – Crossover
NCPeds’ Legislative Agenda

u Assure Medicaid reform works for kids

u Promote workforce adequacy
u Close the coverage gap
u Prevent youth suicide and firearm related deaths and injuries
u Support raising the age
u Assure strong HIEA
u Promote tobacco cessation
Some other bills we are tracking
Patient Protections

u SAVE Act – An Act to Deliver Safe, Accessible, Value-directed and Excellent

health care…by modernizing nursing regulations
u Allows advanced practice registered nurses to practice without supervision

u Nurses have about 5% of the training of pediatricians

u Nurses practice in urban areas in NC
u Team-based care = higher quality and lower cost
Close Coverage Gap

u Parents with two children who earn $12,000 make too much for Medicaid in North
Carolina. However, they can’t get help buying health insurance in the marketplace until
they earn $25,100.

u The healthier adults are before they conceive, the more likely their babies
are to enjoy healthy birth outcomes

u Next few weeks will be critical

Want more? Come to our
April 6th Open Forum and/or WCW
u To get updates, make sure your email address with us is up to date
u NCPeds’ All Advocacy April Open Forum – April 6th, Raleigh
u Breakfast on network adequacy led by Dr. Richard Sutherland at UNC
u Keynote Jay Ludlam, Asst. Secretary for Medicaid
u Panel with many lobbyists and GA update
u Hands-on session for planning a meeting with a legislator in your home district
u White Coat Wednesday – May 15, Raleigh
u Meet at NCMS and then go meet with legislators
u Together with Ob-gyns
u Sign up at NCPeds (
u April 10 – Closing the Gap at Nash UNC Hospital

Elizabeth Hudgins
NC Pediatric Society