Transformation

North Carolina's Transformation to Medicaid Managed Care

Starting July 1, 2021, most Medicaid beneficiaries began receiving the same Medicaid services in a new way. Called "NC Medicaid Managed Care," beneficiaries choose a health plan and get care through a health plan's network of doctors. Some beneficiaries are remaining in traditional Medicaid, which is called NC Medicaid Direct. 

NC Medicaid Managed Care

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.

In July 2020, legislation authorized NC Medicaid Managed Care to begin July 1, 2021, for Standard Plans and July 1, 2022, for Behavioral Health  I/DD Tailored Plans.