Superior Court judge rules in favor of NCDHHS in Medicaid Managed Care transformation case

A superior court judge upheld a previous ruling that the North Carolina Department of Health and Human Services fairly awarded health plan contracts during the procurement process for the soon-to-be-implemented Medicaid Managed Care. Superior court Judge Michael O’Foghluda ruled in favor of NCDHHS in response to a legal challenge by My Health by Health Providers’ Petition for Judicial Review.

 

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In a similar ruling, Aetna’s petition for judicial review was dismissed last November by Superior Court Judge Tanisha Jacob. Aetna has since appealed that ruling.

Despite the legal challenges, the health department will continue to move towards its launch of Medicaid Managed Care on July 1.

In 2019, four physician health plans were given prepaid health plan contracts including UnitedHealth Group, Blue Shield of N.C., Centene and AmeriHealth Caritias N.C.

Cone Health, Novant Health and Wake Forest Baptist Medical Center are among several My Health hospital partners.

The contracts are worth $6 billion in Medicaid contracts, according to Modern Healthcare.

In 2015, the North Carolina General Assembly enacted legislation that directs DHHS to transition Medicaid and North Carolina Health Choice from fee-for-serve to managed care. Under managed care, the state contracts with insurance companies which are paid a predetermined set rate per enrolled individual to provide all services. The new plan was set to begin Feb. 1, 2020. It was delayed over funding and program authority. In June 2020, the passage of SB 808 authorized Medicaid Managed Care to restart with a launch date of July 1, 2021, for standard plans. Behavioral Health I/DD Tailored Plans will begin July 1, 2022.

The transformation is expected to affect 1.6 to 1.8 million individuals.