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Cross-System Navigation in a Managed Care Environment

The goal of this initiative is to develop recommendations for the North Carolina Department of Health and Human Services (DHHS) about how individuals with I/DD and their families can best be supported to effectively navigate across various service systems (cross-system navigation) as DHHS moves toward implementation of Medicaid Transformation. Medicaid Transformation is NC’s plan to transition the physical Medicaid program to managed care to improve overall service delivery and improve the integration of behavioral and I/DD healthcare and physical healthcare services.

Why is NCCDD funding this initiative?Goal2

  • Individuals with intellectual and other developmental disabilities (I/DD) and their families often need assistance to navigate the complex Medicaid/Medicare and State systems of long-term services and supports (LTSS).
  • As a result of the transition to the North Carolina Innovations Waiver starting in 2005, case management and targeted case management functions (which supported individuals with and without Medicaid waiver services) were largely substituted with less robust care coordination and community guide services.
  • With the evolution from a Local Management Entity (LME) system to a Local Management Entity/Managed Care Organization (LME/MCO) system, families and individuals have described taking on greater care coordination and community and service definition exploration without the informed expertise previously provided by case managers leading to confusion, reduced efficacy and unnecessary service interruption or costly outcomes.
  • The structure of care coordination is inconsistent across the state, which has further complicated the ability of individuals with I/DD and their families to help each other navigate such a complex landscape, as what works in one region may not work the same in another.
  • Through Medicaid Transformation, North Carolina is joining the trend of state systems implementing capitated managed care as a strategy for lowering mental health care costs and improving efficiencies. Complicating this, however, is the enhanced supports that individuals with intellectual and other developmental disabilities (I/DD) who are dually diagnosed with behavioral health challenges need to navigate these changing systems.

What are the major goals and objectives?

  • Study the cross-system navigation components (which may pull from case management, care management, and/or community navigator roles and similarly defined roles) that will accompany the plans that the NC Department of Health and Human Services (DHHS) plans to release as it rolls out a managed care system integrating both physical and behavioral health in 2018.
  • Assess the options available to individuals with I/DD who are on Medicaid (both the state plan and the Innovations Waiver) and provide recommendations to meet needs of individuals with I/DD being served as well as individuals with I/DD on the registry of unmet needs waiting for waiver services and for individuals with I/DD on Medicaid as well as individuals with I/DD who have private insurance or no insurance (i.e., are not in the Medicaid service system).
  • By October 2019, produce a Workforce White Paper that will make relevant workforce development recommendations to DHHS, state policymakers, (LME/MCO) leadership and provider leadership.
  • By June 30, 2020, produce a Grant Recommendation Report detailing the workgroup findings regarding navigation support needs for individuals with I/DD and also outlining policy and practice change recommendations.

What has taken place since the start of the program? (Activities)

  • Identify a Cross-System Navigation Advisory Workgroup: collaborate with NCCDD, NC Department of Health and Human Services (DHHS), and advocacy and service provider organizations to convene key stakeholders, including individuals with I/DD and family members.
  • Convene the advisory workgroup quarterly in various locations across North Carolina.
  • Disseminate Workgroup findings. This will be a planned process that involves consideration of target audiences and the settings in which Workgroup findings are to be shared. Where appropriate, communicating and interacting with wider policy and health service audiences in ways that will facilitate research uptake in decision-making processes and practice will occur.

What has been achieved to date?

  • Developed a website for this initiative: www.CrossSystemNavigation.org
  • Started identifying and inviting individuals to become members of the Cross-System Navigation Advisory Workgroup.

What long-term changes are expected as a result of this initiative?

  • NC DHHS and other high-level policymakers will better understand what type of navigation supports are needed for individuals with I/DD who are receiving Medicaid services and individuals with I/DD who are not in the Medicaid service system. As a result, they can make informed decisions that will ensure that the system is responsive to the needs of individuals with I/DD and their families.

Who is the contractor?

i2i logo LG copy

The contractor is i2i Center for Integrative Health.

Who can I contact for questions?

Project Director: Kelly Friedlander, MSW, MPA. Kelly@i2icenter.org

NCCDD: David Ingram, Systems Change Manager. David.Ingram@dhhs.nc.gov


Additional Resources

Click HERE to review a one-pager on the Cross-System Navigation in a Managed Care Environment initiative

For additional information on i2i and i2i’s work on this initiative, visit www.CrossSystemNavigation.org  

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North Carolina Council on Developmental Disabilities
3125 Poplarwood Court
Suite 200
Raleigh, NC 27604
Info@nccdd.org
919-850-2901 (voice/tdd)
800-357-6916 (voice/tdd)
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