Transformation

North Carolina's Transformation to Medicaid Managed Care

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. 

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