NC MEDICAID TRANSFORMATION MOVING FORWARD
North Carolina Medicaid is undergoing a change from a fee-for-service model to a managed care model. This change will affect an estimated 53,000 Robeson County residents currently enrolled in Medicaid programs. NC Medicaid Managed Care, also called Medicaid Transformation, will transform North Carolina Medicaid and North Carolina Health Choice programs in order to measurably improve health, maximize value to ensure program sustainability, and increase access to care. Managed care will be administered by Prepaid Health Plans (PHPs). The PHPs will function much like health insurance companies. PHPs will be paid a capitated rate for all of their members. Doctors will contract with the PHPs and enroll in North Carolina Medicaid. Medicaid covered services will not change under Managed Care.
Letters have already been sent to Medicaid beneficiaries asking them to contact their local Department of Social Services (DSS) to update their mailing addresses in order to prepare for the Managed Care change. The primary role of your local DSS in determining and re-determining eligibility for North Carolina Medicaid will not change. The initial change is that once eligible, Medicaid Managed Care recipients will need to be in communication with an Enrollment Broker.
Managed Care education begins October 1, 2019. Medicaid beneficiaries will begin to receive communications from the Enrollment Broker, a company called Maximus, who will help the beneficiaries to select their PHP and Primary Care Provider (PCP). The PHPs available are AmeriHealth Caritas North Carolina Inc., Blue Cross and Blue Shield of North Carolina, UnitedHealthcare of North Carolina, Inc., WellCare of North Carolina Inc., and Carolina Complete Health.
On December 16, 2019, PHPs and PCPs will be automatically assigned for mandatory (and applicable exempt) beneficiaries who did not select a PHP or PCP with the Enrollment Broker.
It will be mandatory for most Medicaid recipients to participate in NC Medicaid Managed Care. Coverage will begin on February 1, 2020 and at that time, members will begin receiving services from their PHPs and associated PCPs. Beneficiaries will receive Medicaid cards from their PHP.
For more information about Medicaid Managed Care, visit the North Carolina Department of Health and Human Services (NCDHHS) website at www.ncdhhs.gov/assistance/medicaid-transformation or call your local DSS.