In North Carolina, Medicaid Transformation is well under way with most beneficiaries receiving services through Medicaid Managed Care as of July 1st, 2021. In this model, recipients choose an integrated health plan—covering both their physical and mental/behavioral health needs—from one of five prepaid health plans (PHPs) with which the state is contracted. This is a shift from North Carolina’s previous Medicaid system which separated the physical and mental/behavioral health dollars and systems. As a part of this transition, providers were also required to make decisions about seeking contracts with the five selected PHPs.
While such a transition can be very daunting to all providers, many of the medium to large mental and behavioral health care organizations employ staff and/or have whole departments whose expertise and responsibilities include contracting and dealing with documentation. Many larger providers may also have staff dedicated to navigating discussions with individual PHPs on how the agency will continue to cover specialized services, such as Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), Eye-Movement Desensitization and Reprocessing (EMDR) Therapy, specialized assessments, and other services. However, for the many Licensed Independent Practitioners (LIP’s) across the state who operate private practices, the responsibility of navigating these changes often ends up falling solely on their shoulders.
We spoke with a few of the LIPs in partnership with Benchmarks’ Partnering for Excellence (PFE) to delve deeper into Medicaid Transformation from their perspective. Overwhelmingly, they shared that having a network or support has been key during this time. Vatogna Steward, LPC and owner of Therapy to Inner Peace Center revealed that reaching out for support from others in her network, and organizations like the North Carolina Area Health Education Centers (NC AHEC) has been imperative to navigating Medicaid Transformation. Similarly, Sarah OHoro-Nash, LCSW and owner of Achieving Changes Counseling Services has appreciated having a network of peers of which she can lean on to ask questions and share knowledge as information becomes available. Those interviewed shared that being a part of initiatives like PFE has also been helpful during this time. PFE strengthens the relationship of child serving systems by facilitating partnerships among private providers, managed care organizations, and child welfare. Sarah stated that being a part of PFE has been beneficial because “it is helpful for us to have those advocates in our corner helping us and being another voice for ourselves and the individuals we support.”
Of the hurdles that the LIPs shared, the most prevalent concerns have been ensuring that their clients are informed about the changes to their Medicaid services and establishing connections with the PHPs to ensure they have an avenue to ask questions and receive support. Christie Martin, LCSW, and CEO of My Therapy Place, PLLC shared that she has clients who have reported they were unaware of the changes to Medicaid and therefore, she not only has made it a priority to “stay on top of it” for her business but also for the clients served through her practice. For a long time, therapeutic providers have been accustomed to working with the Managed Care Organizations (MCOs) in their service area. However, for LIPs whose coverage area is usually across 1 to 3 counties that oftentimes meant working with 1 or 2 MCOs and having a “go-to” person when questions arose. Medicaid Transformation increased the entities who provide Medicaid managed care by an additional 5 plans; meaning more choice for recipients but also more systems to navigate for practitioners.
To continue to offer the best services to clients while working through the details of Medicaid Transformation, Christie shared her best advice, which is to “advocate and make it happen. As an LIP, I have to block my calendar for time that I will focus on certain things and be disciplined to do those things while fulfilling my obligations.” Vatogna and Sarah would encourage other LIPs to “have a good support system in place and communicate with everyone in your circle of support.” For more information about Medicaid Transformation in North Carolina, visit the North Carolina Department of Health and Human Services website Transformation | NC Medicaid (ncdhhs.gov).