Managed Care for Providers: PHP Contracts Awarded

<p>On Feb. 4, 2019, the North Carolina Department of Health and Human Services announced the selection of five Prepaid Health Plans that will participate in Medicaid managed care when the program launches in November 2019.</p>

Author: https://ncdhhs.gov/medicaid-transformation

On Feb. 4, 2019, the North Carolina Department of Health and Human Services announced the selection of Prepaid Health Plans that will participate in Medicaid managed care when the program launches in November 2019. The Department awarded contracts to five entities:

  • Statewide PHP contracts were awarded to the following entities which will offer Standard Plans in all regions in North Carolina:

        -  AmeriHealth Caritas North Carolina, Inc.

        -  Blue Cross and Blue Shield of North Carolina

        -  UnitedHealthcare of North Carolina, Inc.

        -  WellCare of North Carolina, Inc.

  • A regional PHP contract was awarded to Carolina Complete Health, a provider-led entity, which will offer plans in Regions 3 and 5.

In 2015, the General Assembly directed the transition of Medicaid to a managed care structure. In managed care, DHHS will oversee all aspects of the Medicaid and NC Health Choice programs. However, PHPs will directly manage certain health services, assume financial risk and contract with providers to provide services for beneficiaries.

About 1.6 million Medicaid and NC Health Choice beneficiaries will enroll in a Standard Plan, which will provide integrated physical health, behavioral health and pharmaceutical services. To ease the transition to Medicaid Managed Care, Standard Plans will launch in two phases. The first phase will launch in November 2019 for beneficiaries in the following 27 counties: Alamance, Alleghany, Ashe, Caswell, Chatham, Davidson, Davie, Durham, Forsyth, Franklin, Granville, Guilford, Johnston, Nash, Orange, Person, Randolph, Rockingham, Stokes, Surry, Vance, Wake, Warren, Watauga, Wilkes, Wilson and Yadkin. Standard Plans will launch in the remaining counties in February 2020.

In the coming months, the Department will work with each PHP to implement managed care consistent with the Department’s expectations as outlined in the PHP RFP. Over the summer and fall, the PHPs will complete a readiness review to demonstrate their ability to meet state, federal and contractual requirements. Once implemented, the PHPs will be subject to rigorous oversight by DHHS to ensure strong provider networks, a full range of benefits, accountability for quality and outcomes, a positive beneficiary experience and timely payments to providers among aspects of a successful managed care program. 

A fact sheet with more information can be found at https://files.nc.gov/ncdhhs/medicaid/Medicaid-Factsheets-PHP-2.4.19.pdf. For additional information about Medicaid Transformation, please visit: https://www.ncdhhs.gov/assistance/medicaid-transformation

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