SPECIAL BULLETIN: Carolina Complete Health Awarded Additional Region in Medicaid Managed Care

Tuesday, October 8, 2019

The North Carolina Department of Health and Human Services (DHHS) has expanded the regions awarded to Carolina Complete Health, Inc. (CCH) to serve as a health plan under the state’s transition to Medicaid Managed Care. In addition to serving regions 3 and 5 in the state, the provider-led health plan will also serve region 4.

DHHS and CCH have been working together to ensure the health plan is well-positioned to meet the state’s vision of providing a whole-person system of care that addresses both medical and non-medical drivers of health. As a provider-led entity governed by physicians, CCH brings a unique perspective to Medicaid Managed Care. The agreement resolves CCH’s contested case pending at the Office of Administrative Hearings.

In addition to counties in regions 3 and 5, Medicaid beneficiaries in the following region 4 counties will now have the option to choose Carolina Complete Health Inc. as their health plan: Alamance, Caswell, Chatham, Durham, Franklin, Granville, Johnston, Nash, Orange, Person, Vance, Wake, Warren and Wilson.

Open enrollment for Medicaid Managed Care began in 27 counties in July. Open enrollment statewide will begin on Oct. 14, 2019.

In 2015, the NC General Assembly enacted legislation directing DHHS to transition Medicaid and NC Health Choice from fee-for-service to managed care. Under managed care, the state contracts with insurance companies, which are paid a predetermined set rate per person to provide all services. Transforming North Carolina’s Medicaid program to managed care is the most significant change made since its inception.

Questions regarding Medicaid Managed Care may be emailed to: medicaid.transformation@dhhs.nc.gov

GDIT, (800) 688-6696