North Carolina Residents

State and Local Government

Providers of MH/DD/SA Services

Statistics and Publications

1915 b/c Medicaid Waiver Expansion Plans for Mental Health, Developmental Disabilities and Substance Abuse Services

"Responsible Change to Achieve Easy Access, Better Quality and Personal Outcomes"

Four LMEs responded to the RFA and submitted applications to participate in the State's 1915 (b)/(c) Medicaid Waiver. DMHDDSAS and DMA issued a Special Implementation Update #74 announcing the selection of Mecklenburg County Area MH/DD/SAS as the next LME to participate in the 1915b/c Medicaid Waiver.

Thanks to the four LMEs that responded to the RFA application process".

In April 2005, the N.C. Department of Health and Human Services (DHHS) began the “Piedmont Cardinal Health Plan” a pilot project where Medicaid-funded services for mental health, substance abuse, and development disabilities are provided on a capitation basis in a five-county area through a prepaid inpatient health plan (PIHP). PBH, formerly know as Piedmont Behavioral Healthcare, a local management entity (LME), operates the PIHP and manages state-funded mental health, substance abuse, and developmental disabilities services.

In May of 2009, DHHS elected to expand this pilot project beyond PBH to be phased-in statewide. Toward this goal, The Division of Mental Health Developmental Disabilities and Substance Abuse Services ( DMH/DD/SAS) and the Division of Medical Assistance (DMA) worked in partnership, to submit on behalf of DHHS waiver amendment requests to Centers for Medicare and Medicaid Services ( CMS) in December 2009 to expand the pilot project through the modification of the existing Piedmont Cardinal Health Plan 1915(b) Freedom of Choice waiver and the modification of the 1915(c) Innovations Home and Community Based Services (HCBS) waiver. The links to the CMS Waiver Amendments are listed below which are posted on DMA’s website for review.

DHHS will solicit request for applications (RFAs) from LMEs to operate Medicaid-funded services through capitated PIHPs. DHHS will select and contract with one or more qualified LME applicant(s) that meet the CMS and DHHS regulatory and technical criteria, as well as industry standards for the administrative, clinical, and financial operations of a PIHP.

Based on the continued success of the PBH as a waiver entity (PIHP/LME), and success of another waiver entity, DHHS intends to methodically phase in additional waiver entities with the long range goal of implementation statewide based upon continued proven success. The DMHDDSAS and DMA are collaborating together in the leadership of this initiative.

We invite consumers, families and other stakeholders to send general questions/comments about this initiative to: 1915BC.Waiver.Contact@dhhs.nc.gov.

Last Updated: August 20, 2010