Transformation

North Carolina's Transformation to Medicaid Managed Care

Medicaid puzzle

NCDHHS and CIHA to Create First-in-Nation Indian Managed Care Entity

NCDHHS and the Cherokee Indian Hospital Authority have entered into a contract to support the Eastern Band of Cherokee Indians in addressing the health needs of American Indian/Alaskan Native Medicaid beneficiaries.

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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. 

Contact

NC Medicaid Contact Center
Phone: 888-245-0179
Email: Medicaid.Transformation@dhhs.nc.gov

US Mail
Department of Health and Human Services
Division of Health Benefits
1950 Mail Service Center
Raleigh, NC 27699-1950

Drop-off
Department of Health and Human Services
Adams Building - Reception
101 Blair Drive
Raleigh, NC 27603