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Health Plans

Note: Resource documents, guidance documents, forms, and templates for the NC Managed Care Health Plans have been transitioned to the PHP Contract Data Utility (PCDU) system. 

Notice about NC Medicaid Managed Care

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 Medicaid Managed Care.

Providers: Auto-assignment has been suspended; however, providers should continue to contract with health plans. Please contact the health plans for questions on contracting. 

Background

In 2015, the NC General Assembly enacted legislation directing the Department to transition North Carolina 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 launch managed care Feb. 1, 2020. New funding and program authority were required from the General Assembly to meet this timeline. The General Assembly adjourned in November 2019 without providing new spending and program authority required for the transition to managed care.

Prepaid Health Plan Contracts

The Department entered into six contracts for prepaid health plans ("health plans") on Feb. 4, 2019. Contracts are between the Department and the following health plan providers, with the type of contract indicated:

AmeriHealth Caritas of North Carolina – Statewide Health Plan
Blue Cross and Blue Shield of North Carolina – Statewide Health Plan
UnitedHealthcare of North Carolina – Statewide Health Plan
WellCare of North Carolina – Statewide Health Plan
Carolina Complete Health, Inc. – Regional Contract – Region 3 Health Plan
Carolina Complete Health, Inc. – Regional Contract – Region 5 Health Plan

The contract (i.e., Revised and Restated Request for Proposal (RFP)) reflects the original RFP issued Aug. 9, 2018, with all addenda and negotiation documents incorporated. 
Contract #30-190029-DHB Prepaid Health Plan Services
Contract #30-190029-DHB PHP Amendment 1