NC Medicaid Managed Care enrollment opens

The North Carolina Department of Health and Human Services (NCDHHS) opened enrollment for NC Medicaid Managed Care Monday. The new plans will go into effect July 1. About 1.6 million of the 2.4 million Medicaid recipients will be eligible for the new choice-driven program.

 

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The General Assembly opted to transition to managed care five years ago after fluctuating costs made it difficult to budget. Care will be managed by primary care providers, who will also coordinate mental and behavioral therapy for patients. The new program will also allow for patient choice, Dr. Mandy K. Cohen, NCDHHS secretary, said.

“With the start of NC Medicaid Managed Care open enrollment, families now have the chance to make important decisions about their health care to prepare for managed care launch in July. There are many resources available to help families select the health plans and providers that best meet their specific needs.

There will be five health plans from which eligible Medicaid recipients can choose. All health plans are required to offer the same Medicaid services such as office visits, blood tests and X-rays. Health plans each have their own network of qualified doctors and health care professionals. Health plans also have added services such as educational assistance and programs to have a healthy pregnancy. People can choose a primary care provider from their health plan’s network to deliver Medicaid services.

Primary care providers will also be empowered to refer patients to wrap-around services. For example, food banks will receive referrals from the doctors. The change also means that compensation will be tied to improvements in patients’ care.

Medicaid recipients may need to change providers.

North Carolina requires that managed care companies spend at least 88% of the money they receive from the state on patient care, rather than administrative expenses.

The Eastern Band of Cherokee Indians (EBCI) Tribal Option is an additional managed care option, and the first Indian Managed Care Entity in the nation that is available for federally recognized tribal members and individuals eligible to receive services through the Indian Health Service. 

Open enrollment ends May 14. Beneficiaries who enroll with a health plan during open enrollment will have the opportunity to select a PCP from a list of contracted providers. If they do not choose a health plan before May 14, one will be assigned to them by NC Medicaid. In the first 90 days after their coverage effective date, beneficiaries can change health plans for any reason. After that, unless there is a special reason, beneficiaries cannot change health plans until the next Medicaid recertification date.

Those in specialized Medicaid programs — like the Family Planning Program, the Health Insurance Premium Program or the Program of All-Inclusive Care for the Elderly — will stay in the current program which is administered by NCDHHS. The medically needy and those in Refugee Medicaid will stay in the current program as well.