Health Plans

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 providers submit claims as they do today. Learn more

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

Notice about NC Medicaid Managed Care

Until Medicaid Managed Care launches July 1, 2021, NC Medicaid will continue to operate under the current fee-for-service model, called NC Medicaid Direct, administered by the Department. 

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 is currently on track to launch NC Medicaid Managed Care July 1, 2021.

Prepaid Health Plan Contracts

The Department entered into six contracts for prepaid health plans ("health plans") on Feb. 4, 2019. On Oct. 8, 2019, the Department expanded the regions awarded to Carolina Complete Health, Inc. to include region 4 in addition to the previously awarded regions 3 and 5. 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 Contracts – Region 3 Health Plan, Region 4 Health Plan, 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 and Draft Rate Book
Contract #30-190029-DHB PHP Amendment 1