NC Medicaid: Transformation

North Carolina's Transformation to Medicaid Managed Care

Managed Care Open Enrollment: March 15 – May 14, 2021

NC Medicaid Managed Care open enrollment is underway. Beneficiaries have through May 14 to select a health plan and primary care provider that best suit their families’ needs.

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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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Specialized Foster Care Plan

On July 1, 2023, DHHS will launch a plan to meet the unique needs of children and youth currently and formerly involved in the child welfare system. Find out about the interim plan and how you or your group can get involved.

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Medicaid Managed Care transformation efforts have restarted. Standard 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: Continue accessing health services as you do now. To enroll in Medicaid Managed Care, please contact the Medicaid Enrollment Call Center at 833-870-5500 (TTY: 833-870-5588), download the free NC Medicaid Managed Care mobile app (available on Google Play or the App Store) or visit the NC Medicaid enrollment website.
Providers: 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.