BYH, watching this administration is like watching a mob movie....

Medicaid to manage care differently starting Feb. 1


Jarahnee Burger, an employee with Access East, speaks to Matt Abbott, a representative with WellCare, one of the new choices Medicaid recipients have now.


Karen Eckert
The Daily Reflector

Saturday, October 5, 2019

Most of the people who receive Medicaid benefits will get them delivered in a new way starting in February, according to officials.

Medicaid provides health coverage to people with low incomes and is one of the largest payers for health care in the United States, according to medicare.gov.

To help beneficiaries better understand the new delivery system, the Pitt County Department of Social Services held a Medicaid Plan Preview Day event on Friday in the Mark W. Owens Jr. Auditorium at the Pitt County Agricultural Center.

In the past, North Carolina has used a fee-for-service system when administering Medicaid benefits, which means the state managed and paid for patients' health care services, according to Jan Elliott, DSS director.

As the result of a bill passed in 2015 by the N.C. legislature, in 2020 North Carolina is transitioning to a managed care system, Elliott said,

Elliott said that the intention of the switch to managed care was to control Medicaid costs more effectively and to provide a more holistic approach to health care for Medicaid recipients.

At Friday's event four managed care groups — WellCare, UnitedHealthcare, Blue Cross Blue Shield/Healthy Blue and AmeriHealth Caritas — were on hand to provide information about the pre-paid health plans that each offers. These four groups were awarded contracts in North Carolina to offer managed care plans to beneficiaries.

By visiting tables at the floating event, attendees could learn about the four pre-paid health plans available.

The insurance companies were not at the event to enroll people in their plans, Elliott said. They were there strictly to provide information.

All plans are required to have the same type of Medicaid services that beneficiaries receive now, but each plan offers some "added value" services that are unique, Elliott said.

For example, one plan offers a 13-week voucher for Weight Watchers. Another covers home visits and supplies, such as air filters and mattress covers for asthma, according to literature available at the event.

The idea behind including these extra services is related to the goal of treating each beneficiary holistically, Elliott said.

Beneficiaries will need to enroll in a plan of their choice through an independent enrollment broker, Maximus, a company that also had staff available at the event.

Nawassa Forbes attended the event for both professional and personal reasons.

Forbes is the secretary at Ayden 1 Head Start and was at the event to collect information that she could take back and share with the parents of the children enrolled in Medicaid.

Forbes' daughter also is a Medicaid beneficiary, so Forbes has a personal interest in the new, managed care approach.

She had done some homework about the various plans before attending the event and took advantage of the opportunity to sit down with the enrollment broker and enroll her daughter in a specific plan.

"It was easy. It (took) less than five minutes,” Forbes said.

She said that there were some important dates coming up that beneficiaries needed to know about.

People need to select a plan by Dec. 13, Forbes said. After that date, beneficiaries will automatically be enrolled into a plan.

Elliott echoed that point, saying if individuals don't choose a plan, an algorithm will be used to determine which plan is best for them. If the plan turns out not to be the best choice, beneficiaries be able to make a change up until April 30.

Letters explaining the switch started going out in the mail on Oct. 1, Elliott said. Those who have not yet received their letters should get them soon, she said.

Forbes said that beneficiaries should read the materials they receive in the mail and sign up as soon as possible.

People can sign up online at ncmedicaidplans.gov or call 1-833-870-5500. An enrollment broker also will be available at the Human Services Center, 203 Government Circle, during the enrollment period, which runs through Dec. 13.

If, after looking at the materials they receive in the mail Medicaid recipients don't understand what to do, Forbes recommended that they call the case worker who handles their Medicaid.

Other professionals also hoped to spread the word about the changes.

Jarahnee Burger, a registered nurse who is a case manager and supervisor for Access East, Vidant Health, said she attended the preview event because she wanted to know more about pre-paid plans and would share what she learned with her staff.

The event left her with a positive impression, she said.

"These people in this room care about the Medicaid population,” Burger said. “And each person in this room expressed their passion about this population and it’s a population that’s been underserved for too long.”