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SPECIAL BULLETIN: DHHS Suspends Implementation of Managed Care

Wednesday, November 20, 2019

While this year’s legislative session was one of the longest in recent memory, it ended without needed action required for managed care to move forward. The General Assembly adjourned last week without providing required new spending and program authority for the transition to managed care. Therefore, the Department of Health and Human Services will be suspending managed care implementation and open enrollment. Managed care will not go live on February 1, 2020.

With managed care suspended, NC Medicaid will continue to operate under the current fee-for-service model administered by the Department. Nothing will change for Medicaid beneficiaries; they will get health services as they do today. Behavioral health services will continue to be provided by Local Management Entities – Managed Care Organizations. All health providers enrolled in Medicaid are still part of the program and will continue to bill the state through NCTracks.

The Medicaid Managed Care Call Center (833-870-5500) will stay open through the scheduled open enrollment period to answer questions but will no longer enroll beneficiaries in a health plan. Beneficiaries can continue to contact the Medicaid Contact Center (888-245-0179). Notices will be sent to beneficiaries informing them to continue accessing health services as they do now, rather than through new health plans.

The suspension of work and the wind-down process will begin today.  Once suspended, managed care cannot easily or quickly be restarted. The Department will not decide on a new go-live date until it has program authority within a budget that protects the health and safety of North Carolinians and supports the Department’s ability to provide critical oversight and accountability of managed care.

Both the conference and transformation mini budgets passed during this year’s legislative session and vetoed by the Governor left the department vulnerable to an unprecedented cut that would have had a crippling effect on its ability to provide services that protect people’s health and safety and moved the Department out of Raleigh to Granville County. In addition, neither expanded Medicaid so that hardworking North Carolinians could afford access to health coverage.

The Department is committed to doing its best to mitigate the inevitable confusion for beneficiaries and our many partners.

Author: 
Medicaid.Communications@dhhs.nc.gov