North Carolina has officially launched its Managed Care program for Medicaid, marking a significant shift in how healthcare services are delivered to nearly 1.6 million beneficiaries. Starting July 1st, a majority of these individuals began receiving their Medicaid benefits through NC Medicaid Managed Care health plans, a move designed to enhance the quality and coordination of care across the state. While most beneficiaries will continue to see their existing doctors, they are now enrolled as members of specific health plans, representing a new framework for accessing healthcare services. It’s important to note that some beneficiaries will remain in the traditional NC Medicaid Direct program and will not be enrolled in these managed care health plans.
The transition to managed care in North Carolina is not just a change in administration; it represents a fundamental redesign of the healthcare delivery system. The North Carolina Department of Health and Human Services (NCDHHS) has strategically used this shift to build a system that prioritizes beneficiary health. Key features of this innovative program include a payment structure that incentivizes improved health outcomes, the integration of physical and mental health services, and investments in non-medical support services aimed at both reducing healthcare costs and fostering healthier lives for Medicaid recipients. According to Secretary of NCDHHS, Mandy K. Cohen, M.D., the launch of Medicaid Managed Care on July 1st is a “significant milestone” and a step closer to realizing the state’s goal of a “whole-person centered, and well-coordinated system of care” to improve the health of all North Carolinians.
The journey towards NC Medicaid Managed Care began with legislation in 2015, initiating the state’s transition. Since then, NCDHHS has collaborated extensively with health plans, healthcare providers, beneficiaries, and community organizations. This collaborative approach has been crucial in designing and preparing for the implementation of managed care. Key preparations included establishing quality benchmarks for health plans to meet, developing data-sharing systems across different entities, ensuring adequate provider networks to maintain beneficiary access to care, and creating supportive policies to guide beneficiaries through this transition. Throughout this comprehensive process, NCDHHS has emphasized stakeholder engagement and clear communication, ensuring that those most affected by these changes have had opportunities to provide input and stay informed at each stage. Deputy Secretary of NC Medicaid, Dave Richard, highlighted the state’s preparedness, stating that on “Day One,” the focus is on ensuring uninterrupted care for beneficiaries and timely payments for providers. He also expressed confidence in the health plans’ ability to quickly address any initial challenges as they collectively manage this significant shift in NC Medicaid history.
All beneficiaries transitioning to NC Medicaid Managed Care were enrolled in one of five available health plans or the Eastern Band of Cherokee Indians (EBCI) Tribal Option. This enrollment was achieved either through beneficiary choice during an open enrollment period or via an auto-enrollment process. In June, beneficiaries received welcome packets from their respective health plans, including essential information and new Medicaid ID cards. Importantly, beneficiaries have a period until September 30, 2021, to change their chosen health plan if they wish, providing flexibility and ensuring they can find a plan that best meets their needs.
To support beneficiaries through this transition to NC Medicaid Managed Care, several resources are available to address questions and concerns. For those needing a reminder of their enrolled health plan, the Enrollment Broker can be contacted at 833-870-5500 (TTY: 833-870-5588). Questions regarding specific benefits and coverage details can be directed to the beneficiary’s health plan, using the contact information provided in their welcome packet or the “What Beneficiaries Need to Know on Day One” fact sheet. For other general inquiries, beneficiaries can reach out to the NC Medicaid Contact Center at 888-245-0179 or visit the “Beneficiaries” section of the official Medicaid website.
Furthermore, for beneficiaries encountering issues that cannot be resolved directly with their health plan, the NC Medicaid Ombudsman is available at 877-201-3750. This service provides an additional layer of support and advocacy for beneficiaries navigating the managed care system.
Under the managed care framework, Medicaid providers are now part of health plan networks. To ensure a seamless transition for both beneficiaries and providers, health plans will honor pre-existing approvals for care for the initial 90 days post-July 1st, provided those services are covered under the health plan. Additionally, for the first 60 days after the launch, health plans will pay providers, even those outside of their network, at the same rate as in-network providers. To assist providers in this transition, resources such as the “Provider Day One Quick Reference Guide” and a dedicated fact sheet are available, offering essential information about navigating the managed care system post-launch.
For individuals seeking more detailed information about Medicaid Managed Care in North Carolina, the NC Medicaid website serves as a comprehensive resource. Visit medicaid.ncdhhs.gov/transformation to explore further details about the program and its implementation.
