Medicaid

Nearly 1.6 million Medicaid beneficiaries in NC will begin receiving the same Medicaid services in a new way through NC Medicaid Managed Care health plans.

Nearly 1.6 million Medicaid beneficiaries in North Carolina began receiving the same Medicaid services in a new way through NC Medicaid Managed Care health plans on July 1. Most beneficiaries will continue to get care from the same doctors they see today but will now be a member of a health plan. Some beneficiaries will not enroll with health plans and will remain in NC Medicaid Direct.

NCDHHS has leveraged the move to managed care to build an innovative health care delivery system that puts the health of beneficiaries at the forefront. Features of the state’s program include establishing a payment structure that rewards better health outcomes, integrating physical and behavioral health, and investing in non-medical interventions aimed at reducing costs and improving the health of Medicaid beneficiaries.

“From the start of this process, our goal has been to improve the health of North Carolinians through an innovative, whole-person centered, and well-coordinated system of care,” said North Carolina Department of Health and Human Services Secretary Mandy K. Cohen, M.D.

Since the passage of legislation in 2015 that began the state’s transition to managed care, NCDHHS has worked closely with health plans, providers, beneficiaries and community-based organizations to design and prepare for implementation, including developing benchmarks for quality care that plans must meet, building systems to share data across organizations, ensuring plans have enough providers to maintain access to care and developing policies to support beneficiaries as they transition to this new model.

Throughout this process, NCDHHS has prioritized stakeholder engagement and transparent communication to ensure those most impacted by this change have an opportunity to share input and are informed at each step of the process.

“As our role shifts to provide regulatory oversight, we expect on Day One that people get the care they need and providers get paid,” said Deputy Secretary of NC Medicaid Dave Richard. “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.”

All beneficiaries moving to NC Medicaid Managed Care were enrolled in one of five health plans or the Eastern Band of Cherokee Indians (EBCI) Tribal Option by either selecting a health plan during open enrollment or through the auto-enrollment process. In June, beneficiaries were mailed welcome packets with information from their health plan and new Medicaid ID cards. Beneficiaries have until Sept. 30, 2021, to change plans for any reason.

Beneficiaries have several resources to help answer questions about their transition to NC Medicaid Managed Care. Those who want a reminder of which health plan they are enrolled in should call the Enrollment Broker at 833-870-5500 (TTY: 833-870-5588). Questions about benefits and coverage can be answered by calling their health plan at the number listed in the welcome packet or on the What Beneficiaries Need to Know on Day One fact sheet. For other questions, beneficiaries can call the NC Medicaid Contact Center at 888-245-0179 or visit the “Beneficiaries” section of the Medicaid website.

Additionally, for issues that cannot be resolved with their health plans, beneficiaries can contact the NC Medicaid Ombudsman at 877-201-3750.

Under managed care, Medicaid providers enroll with one or more health plan networks. To support a smooth transition of care for beneficiaries and providers, health plans will honor approvals beneficiaries have already received for care for the first 90 days after July 1 if those services are also covered by the plan. Health plans will also pay providers who may be outside their network at the same rate as their own providers for the first 60 days after launch. Providers can access a Provider Day One Quick Reference Guide and a fact sheet on what providers need to know after Managed Care Launch.

More information on Medicaid Managed Care can be found on the NC Medicaid website at medicaid.ncdhhs.gov/transformation.

Editor’s Note: This article was contributed by the NC Department of Health and Human Services.

The Duplin Times may be reached at duplinnews@ncweeklies.com