North Carolina’s Medicaid program serves a significant portion of its population, providing essential healthcare services. A key initiative, the North Carolina’s Proposed Program Design for Medicaid Managed Care, aimed to transform how these services are delivered. This program sought to shift from a traditional fee-for-service model to a managed care system, intending to improve care coordination, enhance patient outcomes, and control costs. However, recent developments have put this transition on hold, creating uncertainty for beneficiaries and providers alike.
Currently, North Carolina Medicaid operates under its existing structure. Beneficiaries continue to access healthcare services as they have been, directly through the state. There is no immediate requirement for Medicaid recipients to enroll in managed care health plans. Behavioral health services remain under the purview of Local Management Entities – Managed Care Organizations (LME-MCOs). Crucially, all healthcare providers currently enrolled in the North Carolina Medicaid program maintain their participation and will continue to submit claims to the state via NCTracks. Any previously communicated timelines regarding the Medicaid Transformation are no longer applicable. For any immediate questions, the Medicaid Contact Center is available at 888-245-0179.
The proposed program design was a detailed framework developed by the North Carolina Department of Health and Human Services (DHHS). This design was intended to guide the implementation of managed care across the state’s Medicaid and NC Health Choice programs. Released in August 2017, it provided a comprehensive overview of the DHHS vision for managed care, allowing providers and stakeholders to review and provide feedback before the state submitted its amended Section 1115 demonstration waiver application to the Centers for Medicare and Medicaid Services (CMS) in November 2017.
Key components of this proposed design are further elaborated in various policy papers and guidance documents released by DHHS. These documents delve into the specifics of the NC Medicaid Managed Care program’s features and operational aspects. These policy papers and final policy guidance documents are available for review on the DHHS Medicaid website, offering detailed insights into the planned structure and function of the managed care program.
The foundation for this transformation was the Section 1115 Demonstration Waiver. Approved by CMS on October 24, 2018, this waiver was a critical step, granting North Carolina the flexibility to implement innovative approaches in its Medicaid program. Effective from January 1, 2019, through October 31, 2024, the waiver was the result of extensive collaboration among DHHS, beneficiaries, advocates, providers, health plans, lawmakers, and other stakeholders. This collaborative effort aimed to create a managed care program that effectively addresses the unique needs of North Carolina’s Medicaid population. Comprehensive information regarding the Section 1115 Demonstration Waiver, including webcasts, presentations, transcripts, fact sheets, approval letters, and press releases, are publicly accessible, offering a transparent view into the waiver’s development and approval process.
To ensure a robust and responsive program design, DHHS actively sought input from those directly impacted by Medicaid. Public hearings and listening sessions were conducted across North Carolina, providing a platform for beneficiaries, providers, and advocates to voice their opinions and share their experiences. This commitment to stakeholder engagement underscores the DHHS’s dedication to developing a Medicaid program that effectively serves the people of North Carolina. Summaries of public comments collected during April and May 2017 are available, reflecting the valuable feedback received during these crucial listening sessions.
While the transition to managed care is currently paused, understanding the North Carolina’s Proposed Program Design for Medicaid Managed Care remains important. The detailed planning and stakeholder input that went into this proposed program provide valuable context for the future of Medicaid in the state. Access to policy papers, waiver information, and public comment summaries offers a comprehensive understanding of the intended direction and key considerations for North Carolina’s Medicaid program.
