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MEMORANDUM September 14, 2007 Re: Request for three (3) new IMC II positions Page 2 position has been helpful in keeping Medicaid costs down by ensuring recipients choose a primary care provider and ensuring they understand the appropriate use of the health care system. The number of Medicaid recipients has grown significantly since the inception of managed care (from 8,852 to 18,071). At their August 23, 2007 meeting, the Southern Piedmont Community Care Plan (SPCCP) voted to pay fifty percent of the non federal share ($11,871 annual cost) for additional staff time assigned to the Carolina Access or Managed Care programs with the County paying the remaining fifty percent of the non federal share ($11,871). The justification for this is the increase in Medicaid eligible's that we mandated to serve. According to the August 2007 Carolina Access Statewide report, Cabarrus County currently has 18,071 Medicaid eligibles, of these, 16,570 are Managed Care eligible. This position will work with clients to avoid high cost emergency room usage, link them with a primary care provider, provide the capacity to enroll the recipients who are not in the managed care program, and to ensure that we are responsive to medical providers to resolve issues with individual recipients. I am requesting that an additional staff person be added to assume these duties as we do not have the capacity to adequately cover all of the tasks assigned to the County. The Family and Children Medicaid Manual identifies the County's role in Managed Care (Carolina Access) in Section 3435 IV as follows: COUNTY DSS RESPONSIBILITIES A. Designate a county Carolina ACCESS contact and back-up person. 8. Maintain a current and accurate county CA Primary Care Provider Directory. C. Complete the mandatory Carolina ACCESS Enrollment and Exemption Form 'A~ T7: 1) to link recipients with a medical home/PCP or to exempt recipients from participation of application or redetermination, using the exempt policy to determine the appropriate exempt code. Make timely changes for a medical home/PCP as requested by the recipient. Enter the approphate change reason code if applicable. D. Key the CCNC/CA PCP provider number or exempt number in EIS. E. Educate enrollees on how to access medical care as a member of CCNC/CA, and answer recipient questions about CCNC/CA policies. F. Refer CCNC/CA enrollees or providers with questions or concerns outside the scope of CCNC/CA enrollment and education to the approphate individual or agency. G. Provide a Carolina ACCESS, The Benelits of Being a Member, (attachment 13) handout to every NCHC applicant at application and NCHC recipient at review. The Carolina ACCESS brochure must continue to be given to the Medicaid recipients. H. Assist members in choosing a medical home/PCP based on location of the recipient, medical history, or physical needs. Assist members in locating medical providers, i.e., dentists. Cabarrus Health Alliance Outpost In June, the Cabarrus Health Alliance (CHA) approached the Department about providing an IMC at their location to take and process applications for their patients. Due to high caseloads and unmet needs at the main office, we determined that we could not meet the request with existing staff and provided CHA management with cost information for an additional position. On September 12, 2007 CHA expressed their interest and willingness to assume the nonfederal share of an on-site Medicaid eligibility specialist. The County would not incur any direct cost for this position. Summary: The DSS Board voted at their September 25, 2007 meeting to support the request for the three Income Maintenance Caseworker positions. The anticipated salary and fringe for the three (3) positions in FY08 is $69,547.00 with anticipated revenue of $61,898.00. As you can see, the investment to the County with obtaining 3 additional/needed FTE's to meet state and federal requirements is significant. Therefore, we are requesting your approval of the additional FTE's at an anticipated cost of $7,650. A budget amendment for the three (3) requested positions is attached. Thank you for your consideration. ~-