Sean Libby’s Post

North Carolina Medicaid Expansion GO-LIVE was a SUCCESS! Together with our Clients, MHC Services Group embarked on a transformative journey towards a more inclusive and effective healthcare system in North Carolina. We are helping pave the way for a healthier, more resilient North Carolina, where the benefits of Medicaid expansion are realized to their fullest potential! Medicaid expansion launched in North Carolina on Dec. 1, 2023. NC Medicaid expansion will allow more people to get health care coverage. The eligible population will increase for adults ages 19 through 64 earning up to 138% of the Federal Poverty Level.   NC Medicaid expansion is expected to provide coverage for the following:   • ~300K members moving from family planning program.   • ~100K members currently on Medicaid that lost their eligibility during recertification in the absence of expansion.   • ~200K individuals are expected to apply and be eligible for this program in the first two years. MHC Services Group's commitment to excellence began with a comprehensive understanding of the unique challenges and opportunities presented by the Medicaid expansion initiative. Leveraging our deep industry expertise, we collaborate with stakeholders to design and execute customized strategies that align with North Carolina's healthcare vision. Implementation success hinges on meticulous planning and execution. MHC Services Group consultants work hand-in-hand with our North Carolina Clients, offering strategic insights and practical solutions to streamline processes, enhance operational efficiency, and maximize the impact of the Medicaid expansion on healthcare delivery. Key features of our consulting support during the Medicaid expansion: 1. Strategic Planning: Tailored strategies aligned with North Carolina's healthcare objectives. 2. Collaborative Approach: Work seamlessly with your team to ensure a unified vision and execution. 3. Operational Efficiency: Streamlined processes for optimized resource utilization. 4. Thorough Testing: Rigorous evaluation to identify and address potential challenges proactively. 5. Continuous Improvement: Ongoing support for refinement and enhancement post-implementation. To learn more, click here.  https://lnkd.in/dfhhfmAx #MHC #MHCservicesgroup #implementation #systemsimplementation #coreadministration #coreadministrationimplementation #payers #payer #payerimplementation #payercoreadministration #healthcareimplementation #healthcaretechnology #healthcarepayertechnology #implementationpartner #healthIT #healthtechnology #claimsadministration #claimsadministrationimplementation

Navigating the process to become eligible for Long Term Care (LTC) Here's a simplified roadmap: Medicaid Eligibility Check: Begin by assessing your eligibility for Medicaid, considering income and asset limitations required for MLTC enrollment. Needs Assessment: Undergo a comprehensive evaluation to gauge your long-term care requirements, encompassing health status, daily activities, and necessary support. Referral to MLTC Plan: Upon meeting eligibility criteria, you may receive a referral to a Managed Long Term Care Plan (MLTC Plan), offering a spectrum of services such as home care and transportation. MLTC Plan Selection: Take charge of your care by selecting the MLTC Plan that aligns with your needs and preferences. Evaluate plans based on service offerings and quality of care. Seek assistance from the New York Medicaid CHOICE Helpline or contact plans directly. Enrollment in MLTC: Complete enrollment formalities for your chosen MLTC Plan, providing detailed information about your healthcare preferences and requirements. Collaborate with the plan to develop a personalized care plan. Regular Assessments: Expect periodic reassessments of your health and care needs to ensure ongoing suitability of services provided. This facilitates adjustments to your care plan as necessary. Self-Advocacy: In case of challenges or disagreements, exercise your right to appeal decisions. MLTC plans have established appeal processes, and you can seek support from organizations specializing in navigating the MLTC system. By diligently checking Medicaid eligibility, undergoing needs assessments, actively choosing an MLTC Plan, and remaining engaged throughout the process, you can secure appropriate long-term care services in New York. Don't hesitate to seek guidance from professionals if you encounter any obstacles along the way. . . . . . . . . . Guide to Accessing Long-Term Care: Simplified Steps for MLTC Eligibility #homecare #mltc #longtermcare #managedlongtermcare #healthcare #elderlycare #guide #enrollmentmanagement #enrollmentspecialist

Working with Dual Special Needs Plan Members for 10+ years has motivated me to help improve our Healthcare system. Why should DSN-P member populations be the primary focus for payers in the near future? "Although dually eligible beneficiaries made up 19 percent and 14 percent of all Medicare and Medicaid enrollees, respectively, they accounted for 34 percent of total Medicare spending and 30 percent of total Medicaid spending in calendar year (CY) 2020 (MACPAC and MedPAC 2023)." These plans are continuing to grow at a rapid pace in 2023. Our teams are working to better understand these members through data-driven analysis and behavioral science processes to improve their overall member experience and engagement with their health plans. Improving your member's health and lifestyles through preventive visits, orchestrated care coordination, activities of daily living, and Social Determinants of Health (SDoH) allows us to reduce your administrative costs while increasing member “health-spans”, not just lifespans. If you work directly with DSN-P member populations, I'd love to connect and hear your insights to understand what strategies have worked for you while sharing the value we’ve provided to other payers by effectively engaging and improving DSN-P member health outcomes. Catch me at #NCQA #hlth2023 or #MHPA and let's chat.   We can all work to serve these members - better together.

HFS TO EXTEND CURRENT MCO CONTRACTS IN HEALTHCHOICE ILLINOIS FOR AN ADDITIONAL YEAR | Helpful extension... The Department of Healthcare and Family Services will extend its current contracts with Medicaid managed care organizations in the HealthChoice Illinois program for an additional year as new leadership settles in, Director Elizabeth Whitehorn said Friday. [Health News Illinois] Whitehorn, who began the role in January, told members of the Medicaid Advisory Committee that the decision to postpone the procurement process by a year would give them the “appropriate time to ensure the process is designed to drive healthcare transformation.” “We really value input from our stakeholders and our customers and believe that incorporating the feedback at the front end will lead to a better final procurement,” Whitehorn said. The contracts are currently in the sixth year of an eight-year deal, she said. HealthChoice Illinois covers roughly 80 percent of all the state's Medicaid enrollees. The focus for future contracts will include prioritizing behavioral health, maternal and child health, health equity and “accountability," Whitehorn said. That will include higher standards for performance metrics, financial withholds for both pay-for-performance and pay-for-reporting elements, and standardizing quarterly reviews of individual plan performances. “We'll continue to grow the team and have some fresh perspective on how we work with our MCOs,” Whitehorn said. “I really hope this additional time will ensure the success of procurement for the agency, for the state and — most importantly — for our customers.” The department is working on requests for proposals for a new fully integrated dual-eligible special needs plan, she said. That comes after the Centers for Medicare and Medicaid Services notified the state that it will not extend the Medicare-Medicaid Alignment Initiative demonstration program past 2025. The program covers about 90,000 consumers who are dually eligible for Medicaid and Medicare. The requests for proposals are expected to be released later this spring. For more news and updates , visit IOMC's Blog here> https://lnkd.in/gfb8mw6M #achieve #blackleadership #latinoleaders #families #medicaid #medicare #behavioralhealth #maternalhealth #socialchange #healthequity #publichealth #populationhealth #communityhealth

The Centers for Medicare and Medicaid Services (CMS) has introduced AHEAD, a program offering fixed annual payments to participating hospitals based on prospective budgets. This model will lead states to leverage their existing relationships to recruit hospitals for global budgets. AHEAD is a vital step in addressing healthcare disparities and improving overall population health. #healthcare #cms #ahead #populationhealth

HFS TO EXTEND CURRENT MCO CONTRACTS IN HEALTHCHOICE ILLINOIS FOR AN ADDITIONAL YEAR | The Department of Healthcare and Family Services will extend its current contracts with Medicaid managed care organizations in the HealthChoice Illinois program for an additional year as new leadership settles in, Director Elizabeth Whitehorn said Friday. [Health News Illinois] Whitehorn, who began the role in January, told members of the Medicaid Advisory Committee that the decision to postpone the procurement process by a year would give them the “appropriate time to ensure the process is designed to drive healthcare transformation.” “We really value input from our stakeholders and our customers and believe that incorporating the feedback at the front end will lead to a better final procurement,” Whitehorn said. The contracts are currently in the sixth year of an eight-year deal, she said. HealthChoice Illinois covers roughly 80 percent of all the state's Medicaid enrollees. The focus for future contracts will include prioritizing behavioral health, maternal and child health, health equity and “accountability," Whitehorn said. That will include higher standards for performance metrics, financial withholds for both pay-for-performance and pay-for-reporting elements, and standardizing quarterly reviews of individual plan performances. “We'll continue to grow the team and have some fresh perspective on how we work with our MCOs,” Whitehorn said. “I really hope this additional time will ensure the success of procurement for the agency, for the state and — most importantly — for our customers.” The department is working on requests for proposals for a new fully integrated dual-eligible special needs plan, she said. That comes after the Centers for Medicare and Medicaid Services notified the state that it will not extend the Medicare-Medicaid Alignment Initiative demonstration program past 2025. The program covers about 90,000 consumers who are dually eligible for Medicaid and Medicare. The requests for proposals are expected to be released later this spring. For more news and updates , visit IOMC's Blog here> https://lnkd.in/gfb8mw6M #families #medicaid #medicare #behavioralhealth #maternalhealth #socialchange #healthequity #publichealth #populationhealth #communityhealth  

In an attempt to improve population health and advance health equity, the Centers for Medicare & Medicaid Services recently announced its voluntary States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model in which participating hospitals would receive a fixed payment amount in advance of a prospectively set budget per year. The States Advancing AHEAD Model aims to better address #ChronicDisease, #BehavioralHealth, and other medical conditions by testing a state’s ability to improve the overall healthcare management of its population. According to the CMS, states participating under the AHEAD Model will be better equipped to promote #HealthEquity, increase access to primary care services, set #healthcare expenditures on a more sustainable trajectory, and lower healthcare costs for patients. What do you think about this latest initiative? I’d love to hear from you in the comments. Learn more about the AHEAD Model in Healthcare Finance News: https://bit.ly/44K2Uxp

Offering hybrid payment for primary care (combining fee-for-service with population-based payments) gives health care providers greater flexibility to meet the needs of their patients, enabling more comprehensive, coordinated, team-based #primarycare that leads to #wholepersonhealth. NAACOS, Primary Care Collaborative (PCC), and dozens of other organizations have called for Centers for Medicare & Medicaid Services (CMS) to implement a primary care hybrid payment option in the Medicare Shared Savings Program (MSSP). Read more on our recommendations: https://lnkd.in/ecUf9SRZ This project from Center for Health Care Strategies draws on lessons from five state Medicaid programs to outline key considerations for implementing primary care hybrid payment models in #Medicaid. Read more: https://lnkd.in/eCFmBcQ8 #valuebasedcare