Latest on Medicaid Plan to Address Child Welfare System

NC DHHS published the latest version of the North Carolina’s Child and Family Specialty Plan, the fourth Medicaid managed care plan included in the North Carolina Medicaid Transformation.  Big changes were included in this update after a stakeholder input process was completed.  Comments on this draft plan were requested by March 4^th. 

Eligibility:  The most obvious change is the title, shifting from a specialized foster care plan to the Child and Family Specialty Plan (CFSP).  The title is indicative of an even bigger change to expand the group of Medicaid members in the CFSP.   It now includes:

Mandatory enrollment of Medicaid and Health Choice children and youth in foster care–

• Children receiving adoption assistance

• Former foster youth (FFY) under age 26

• Minor children of children and youth in foster care or former foster youth under 26 years old eligible for CFSP enrollment

Voluntary enrollment for Medicaid and Health Choice members who are—

• Parents, guardians, and custodians of children/youth in foster care

• Siblings of children/youth in foster care

• Family members receiving CPS In-Home Services:

o All adults included as caregivers in the CPS In-Home Services Agreement

o All children included in the CPS In-Home Services Agreement

Alignment with System of Care:  The Child and Family Specialty Plan is being developed using the System of Care framework.  The Plan will be expected to have its care management approach interface with community collaboratives and community-based organizations. 

Implementation Date:  With all of these changes, it is not surprising that the State has pushed back the implementation date from July 1, 2023 to December 1, 2023.  The contract awarded will be an integrated and managed plan with one entity responsible for the entire State.

Service Array:  The service array under the CFSP will be nearly as comprehensive as the BH/IDD Tailored Plan with some exceptions.  The BH/IDD Tailored Plans will continue to be the sole managers of the Innovations and Traumatic Brain Injury Medicaid waivers, the Transition to Community Living Initiative, services in Intermediate Care Facilities for individuals with intellectual disabilities (ICF-IID), State-funded services, and respite services through TRACK at Murdoch Center.  Therefore, any Medicaid member who qualifies for these specific services, waivers and initiatives, will remain in the BH/IDD Tailored Plan regardless of their eligibility for the CFSP.  (See appendix, page 18 of proposal)

Emphasis on Care Management:  Interestingly, the proposal does not mention Child and Family Teams but rather emphasizes the role of the care manager, a multidisciplinary approach, and a care plan team.  The proposal includes the concept of co-locating a care manager with the local department of social services. 

Interim Plan for Smooth Transition Includes Stakeholder Input:  NC DHHS has committed to making this transition for children, youth and families as smooth as possible by having an interim plan and gaining stakeholder input to:

• Ensure children receive a full range of physical and behavioral health services.
• Leverage the existing NC Medicaid Direct primary care and LME/MCO behavioral health system while directly addressing challenges and mitigating problems children in foster care face today.
• Ensure children in foster care receive increased coordination of care.
• Include legislative changes necessary to support the 2023 launch of the Children and Families Specialty Plan that enables children’s access to behavioral health services.

Timeline for Moving Forward:

• Release CFSP Request for Proposals (RFP): Summer 2022
• Award CFSP Contract: Fall 2022
• Implementation Planning for CFSP Launch: Fall 2022 – Winter 2023
• Launch CFSP: By December 2023

For More Information:

February 18, 2022 proposal white paper linkFebruary 17, 2022 webinar presentation link