North Carolina has indeed transitioned to a managed care program for its Medicaid beneficiaries. As of July 1, a significant change occurred in the state’s healthcare system with the official launch of NC Medicaid Managed Care. This initiative impacts nearly 1.6 million Medicaid recipients in North Carolina, introducing a new way for them to access healthcare services. While most beneficiaries can continue seeing their current doctors, they are now enrolled in health plans under this new system. It’s important to note that some specific beneficiary groups will remain in the traditional NC Medicaid Direct program and will not be part of the managed care transition.
This shift to managed care represents a significant overhaul of North Carolina’s Medicaid system. The North Carolina Department of Health and Human Services (NCDHHS) has designed this program to be an innovative healthcare delivery system. A core objective is to prioritize the health of Medicaid beneficiaries. Key features of NC Medicaid Managed Care include a payment structure incentivizing improved health outcomes, the integration of physical and mental healthcare services, and investments in community-based interventions aimed at both cost reduction and enhanced health for beneficiaries.
According to Mandy K. Cohen, M.D., Secretary of NCDHHS, “July 1 marks a significant milestone with the official launch of Medicaid Managed Care in North Carolina.” She emphasized that the overarching goal from the program’s inception has been “to improve the health of North Carolinians through an innovative, whole-person centered, and well-coordinated system of care.” This launch is a crucial step towards realizing that vision and implementing a more effective healthcare model.
The journey to managed care in North Carolina began with legislation passed in 2015. Since then, NCDHHS has collaborated extensively with health plans, healthcare providers, beneficiaries, and community organizations. This collaborative approach was crucial in designing and preparing for the implementation of NC Medicaid Managed Care. Key preparatory steps included establishing quality benchmarks for health plans, creating data-sharing systems across different entities, ensuring adequate provider networks to maintain healthcare access, and developing supportive policies for beneficiaries during this transition. Throughout this process, NCDHHS has emphasized transparent communication and engagement with stakeholders, ensuring that those most affected by these changes have opportunities to provide input and stay informed.
Dave Richard, Deputy Secretary of NC Medicaid, highlighted the state’s preparedness for the launch. “As our role shifts to provide regulatory oversight, we expect on Day One that people get the care they need and providers get paid,” Richard stated. He also acknowledged the expectation of initial challenges and expressed confidence that health plans will quickly address any issues that arise, underscoring the collaborative effort to implement this major change in NC Medicaid’s history.
For beneficiaries transitioning to NC Medicaid Managed Care, enrollment in one of five health plans or the Eastern Band of Cherokee Indians (EBCI) Tribal Option was facilitated through either self-selection during open enrollment or an auto-enrollment process. In June, beneficiaries received welcome packets from their respective health plans along with new Medicaid ID cards. Importantly, beneficiaries have a period until September 30, 2021, to change their health plan if they wish to do so, for any reason.
To support beneficiaries through this transition, several resources are available to answer their questions about NC Medicaid Managed Care. For those needing to confirm their enrolled health plan, contacting the Enrollment Broker at 833-870-5500 (TTY: 833-870-5588) is recommended. Questions about specific benefits and coverage can be directed to the beneficiary’s health plan using the contact information in their welcome packet or the “What Beneficiaries Need to Know on Day One” fact sheet. For other inquiries, the NC Medicaid Contact Center at 888-245-0179 and the “Beneficiaries” section of the Medicaid website are valuable resources. Additionally, the NC Medicaid Ombudsman at 877-201-3750 is available to assist with unresolved issues with health plans.
Under managed care, Medicaid providers are now part of health plan networks. To ensure a smooth transition for both beneficiaries and providers, health plans will honor pre-existing care approvals for the first 90 days post-launch, provided the services are covered by the plan. Furthermore, for the initial 60 days after launch, health plans will pay out-of-network providers at the same rate as in-network providers. Providers can access resources such as the Provider Day One Quick Reference Guide and a fact sheet for essential information regarding the Managed Care launch.
For more detailed information about Medicaid Managed Care in North Carolina, the NC Medicaid website provides comprehensive resources at medicaid.ncdhhs.gov/transformation. This website serves as a central hub for understanding the program, its benefits, and how it impacts beneficiaries and providers across North Carolina.
