NC Medicaid: Transformation

North Carolina's Transformation to Medicaid Managed Care

DHHS Suspends Implementation of Medicaid Managed Care

Beneficiaries get Medicaid physical and behavioral health services as they do now. They do not need to choose a health plan. Medicaid providers submit claims through NCTracks as they do today, and should continue contracting with health plans.

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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. New funding and program authority was required from the General Assembly to meet this timeline.

With Medicaid Managed Care suspended, NC Medicaid will continue to operate under the current fee-for-service model administered by the Department. The Department will not decide on a new go-live date until it has program authority within a budget that protects the health and safety of North Carolinians and supports the Department’s ability to provide critical oversight and accountability of managed care.

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.