Transformation

North Carolina's Transformation to Medicaid Managed Care

Medicaid puzzle

DHHS Resumes Implementation of Managed Care for Launch on July 1, 2021

More information about transformation to managed care will be shared in the future. Until Managed Care goes live in 2021, Medicaid beneficiaries get care and Medicaid provider submit claims as they do today.

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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 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.

Medicaid Managed Care is now scheduled to go live on July 1, 2021. 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: Auto-assignment has been suspended; however, 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 the suspension of Medicaid Managed Care. Procurement efforts that are underway will continue.

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