RALEIGH – Nearly 1.6 million Medicaid beneficiaries in North Carolina began receiving the same Medicaid services in new ways on Thursday.
NC Medicaid Managed Care was launched on Thursday.
Most beneficiaries continue to be treated by the same doctors they see today, but are now on a health plan, according to the North Carolina Department of Health. Some beneficiaries will not sign up for health insurance and will stay with NC Medicaid Direct.
The state took advantage of the move to managed care to build an innovative health care system that, according to the NCDHHS, puts the health of beneficiaries first. Features of the government 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 recipients.
“July 1st marks a significant milestone with the official launch of Medicaid Managed Care in North Carolina,” said Dr. Mandy Cohen, NCHDDS secretary. “From the very beginning of this process, our goal has been to improve the health of the North Carolinians through an innovative, well-coordinated, whole-person care system. Today brings us closer to that goal as we begin implementing this important program. “
Since the passage of laws in 2015 that ushered the state’s transition to managed care, NCDHHS has worked closely with health plans, care providers, beneficiaries and community-based organizations to design and prepare for implementation, including developing benchmarks for a qualitative quality care that the plans must meet, establishing systems to share data between organizations, ensuring that the plans have enough providers to maintain access to care, and developing guidelines to help beneficiaries migrate to this new model.
All benefit recipients who switched to NC Medicaid Managed Care were placed on one of five health plans or the Eastern Band of Cherokee Indians (EBCI) tribal option, either by selecting a health plan during open enrollment or through the automatic enrollment process, NCDHHS. In June, beneficiaries received welcome packs containing information from their health plan and new Medicaid ID cards. Beneficiaries have until September 30th to change their plans for any reason.
There are several resources available to beneficiaries to answer questions about their transition to NC Medicaid Managed Care. Those who want to remember which health plan they are enrolled on should call the Enrollment Broker at 833-870-5500 (TTY: 833-870-5588). Questions about benefits and insurance cover can be answered by phone at the number given in the welcome package or in the leaflet What beneficiaries need to know on the first day. 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, beneficiaries can contact the NC Medicaid Ombudsman at 877-201-3750 for issues that their health plans cannot resolve.
Under Managed Care, Medicaid providers register with one or more health insurance networks. To support a smooth transition of care for beneficiaries and service providers, health insurers will recognize approvals that beneficiaries have already received for care for the first 90 days after July 1, if these benefits are also covered by the plan. Health plans also pay providers who may be outside their network at the same price as their own providers for the first 60 days after launch. Providers can access a Quick Start Guide for Day One provider and a leaflet that provides information that providers need to know after adopting managed care.
For more information on Medicaid Managed Care, see the NC Medicaid website at medicaid.ncdhhs.gov/transformation.