Starting July 1st, North Carolina initiated a significant shift in its healthcare system by launching the Nc Medicaid Managed Care Program. This transformative program impacts nearly 1.6 million Medicaid beneficiaries, introducing a new approach to healthcare delivery through managed care health plans. While most beneficiaries can continue receiving care from their existing doctors, they are now enrolled as members of these health plans, marking a significant change in how healthcare services are accessed and managed within the state. It’s important to note that some beneficiaries will remain in NC Medicaid Direct, ensuring continued care without health plan enrollment.
This move to managed care represents an innovative step by the North Carolina Department of Health and Human Services (NCDHHS) to create a healthcare delivery system centered around beneficiary well-being. The NC Medicaid Managed Care program is structured with key features designed to enhance healthcare quality and efficiency. These include a payment model that incentivizes improved health outcomes, the integration of physical and behavioral health services, and strategic investments in non-medical interventions. These interventions aim to proactively address factors that can impact health, ultimately reducing costs and fostering healthier lives for Medicaid beneficiaries.
Dr. Mandy K. Cohen, former Secretary of the NCDHHS, highlighted the program’s significance, stating, “July 1 marks a significant milestone with the official launch of Medicaid Managed Care in North Carolina.” She emphasized the program’s overarching goal: “to improve the health of North Carolinians through an innovative, whole-person centered, and well-coordinated system of care.” This launch represents a crucial step towards realizing this vision and implementing a more effective and patient-focused healthcare system.
The journey to implement NC Medicaid Managed Care began with legislation in 2015. Since then, NCDHHS has collaborated extensively with various stakeholders, including health plans, healthcare providers, beneficiaries, and community-based organizations. This collaborative approach ensured a well-designed and carefully prepared implementation process. Key preparations included establishing benchmarks for quality care that health plans must adhere to, developing data-sharing systems across different entities, ensuring adequate provider networks to maintain healthcare access, and creating supportive policies to facilitate a smooth transition for beneficiaries into this new healthcare model. Throughout this complex process, NCDHHS prioritized transparent communication and active stakeholder engagement, ensuring that those most affected by these changes were informed and had opportunities to provide input at each stage.
Dave Richard, Deputy Secretary of NC Medicaid, addressed the practical aspects of the launch, stating, “As our role shifts to provide regulatory oversight, we expect on Day One that people get the care they need and providers get paid.” He also acknowledged the potential for initial challenges, adding, “We also anticipate that health plans will quickly address any bumps in the road as we work together to implement the largest change in NC Medicaid’s history.” This statement underscores the commitment to ensuring immediate access to care and addressing any implementation issues promptly through collaborative efforts.
All beneficiaries transitioning to NC Medicaid Managed Care were enrolled in one of five health plans or the Eastern Band of Cherokee Indians (EBCI) Tribal Option. This enrollment occurred either through active selection by beneficiaries during the open enrollment period or through an auto-enrollment process. In June, beneficiaries received welcome packets containing essential information from their respective health plans along with new Medicaid ID cards. Importantly, beneficiaries have a 90-day period, until September 30, 2021, to change their health plans for any reason, providing flexibility and choice in their initial plan selection.
To support beneficiaries through this transition, several resources are available to address questions and provide guidance regarding NC Medicaid Managed Care. Beneficiaries seeking to confirm their enrolled health plan can contact the Enrollment Broker at 833-870-5500 (TTY: 833-870-5588). For specific inquiries about benefits and coverage, beneficiaries are encouraged to contact their health plan directly using the contact information provided in their welcome packet or the “What Beneficiaries Need to Know on Day One” fact sheet. For general questions or further assistance, the NC Medicaid Contact Center can be reached at 888-245-0179, or beneficiaries can visit the dedicated “Beneficiaries” section of the Medicaid website.
Furthermore, for beneficiaries encountering issues that cannot be resolved directly with their health plans, the NC Medicaid Ombudsman is available to provide assistance. The Ombudsman can be contacted at 877-201-3750, serving as an additional resource to ensure beneficiary concerns are addressed effectively.
Under the managed care framework, Medicaid providers are now part of health plan networks. To facilitate a seamless transition for both beneficiaries and providers, health plans are committed to honoring pre-existing approvals for care for the first 90 days post-launch, provided these services are covered under the plan. Additionally, to ensure continued access to care, health plans will reimburse out-of-network providers at their in-network rates for the initial 60 days after the program launch. Providers can access valuable resources such as the “Provider Day One Quick Reference Guide” and a fact sheet providing essential information for providers navigating the post-Managed Care Launch environment.
For those seeking more in-depth information regarding Medicaid Managed Care, the NC Medicaid website offers comprehensive details at medicaid.ncdhhs.gov/transformation. This online resource serves as a central hub for understanding the program, its benefits, and its impact on North Carolina’s healthcare landscape. The NC Medicaid Managed Care program represents a significant step forward in the state’s commitment to providing high-quality, accessible, and efficient healthcare to its Medicaid beneficiaries.
