Transformation

Medicaid Managed Care transformation efforts have restarted. Standand Plans are scheduled to go live July 1, 2021, while Behavioral Health I/DD Tailored Plans are scheduled to launch July 1, 2022. Until that time, NC Medicaid will continue to operate under the current fee-for-service model administered by the Department. 

• Beneficiaries: Notices will be sent to beneficiaries informing them to continue accessing health services as they do now, rather than through new health plans. Beneficiaries can call the Medicaid Contact Center (888-245-0179) with questions.
• Providers: Providers should continue to contract with health plans.

The Medicaid Transformation website contains policy papers, fact sheets and other transition documents with information effective on the date published. They do not reflect current launch dates. 

Background
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 enrolled person to provide all services. The Department was on track to go live Feb. 1, 2020; however, new funding and program authority were required from the General Assembly to meet this timeline and Medicaid Managed Care was suspended in November 2019. In July 2020, legislation authorized the restart of Medicaid Managed Care transformation efforts with a July 1, 2021, launch date for Standard Plans and a July 1, 2022, launch date for Behavioral Health I/DD Tailored Plans.