1915 (b)(c) Medicaid Waiver

On March 31, 2011, the State issued a Request for Applications (RFA) for the Expansion of the Medicaid 1915 (b)/(c) Waiver, also known as the Prepaid Inpatient Health Plan (PIHP).  

Due to the population requirements, Mental Health Partners proposed to merge with Pathways LME and Crossroads Behavioral Healthcare.  Mental Health Partners’ Board of Directors, the Consumer and Family Advisory Committee, Burke County Board of Commissioners and Catawba County Board of Commissioners supported the proposal to join with Pathways LME and Crossroads to meet the state mandated population threshold and apply for the Expansion of the Medicaid 1915 (b)/(c) Waiver.  The application and plan for implementation was due on May 20, 2011.

KEY POINTS IN THE APPLICATION:

• LMEs will not get a second chance after the May 20, 2011 RFA deadline. Applicants will be certified as Managed Care Organizations (MCOs) and will be offered a vendor contract to provide managed care functions.

• The LME applying to operate a Prepaid Inpatient Health Plan must have at a minimum 70,000 Medicaid eligible ages 3 and older and a total population of 300,000 by July 2012 and a total population of 500,000 by July 2013 to provide LME and managed care functions.

• LMEs must identify which LME or LMEs with which they will "partner" to perform the required functions. If LMEs do not identify working partners, then Department of Health and Human Services will assign partners.

The joint application between Mental Health Partners, Pathways and Crossroads passed the initial desk review.  To that end, a site review was conducted on June 30, 2011.  We anticipate that the State will notify us of their decision at the first of August.   Joint meetings of the three Boards of Directors and the three Consumer and Family Advisory Committees are scheduled for August and September.

We will be working with consumers, staff, providers, and stakeholders to develop the best organization to meet the needs of our citizens and continue to post updates on our web site.

The new organization, consisting of eight counties (Burke, Catawba, Cleveland, Gaston, Iredell, Lincoln, Surry and Yadkin) will become operational July 1, 2012.  The Medicaid Waiver will become effective January 1, 2013.

Questions can be sent to jdahlstrom@mentalhealthpartners.org.

To view the application, click here.