This webpage is designed to alert providers to up-to-date information from the State regarding Medicaid Transformation. To assist with a smooth transition, Alliance is encouraging its providers to become familiar with Medicaid Transformation and what it means for our members. This page will be updated with new information as it comes in so it is highly recommended that you check back here and the DHHS Medicaid Transformation website for regular updates.
Alliance will also provide updated information in the Provider News Service. Providers can sign up for and see the most recent newsletter.
NC’s plan for Medicaid Transformation will embody whole person care. This involves providing services and supports for a member’s physical, pharmaceutical, behavioral and social determinant needs. There will be two separate identified plans – Standard Plans and Tailored Plans.
Delay in Medicaid Transformation
NC DHHS shared its plan on November 19, 2019 to suspend implementation of Medicaid managed care due to the continuing state budget impasse. Alliance has been informed by DHHS that the Tailored Plan Request for Application (the procurement process for the Tailored Plan) remains on schedule for release in February 2020.
UPDATE: Due to the delay in the launch of NC Medicaid Managed Care, training materials provided here are no longer current.
- Throughout autumn of 2019, LME-MCOs and NC DHHS jointly sponsored provider trainings on NC’s transition to Medicaid Managed Care in anticipation of the program’s February 1, 2020 launch date.
- NC Managed Care will not go live on February 1, 2020.
- Trainings are posted for reference purposes only and do not reflect this recent suspension. Dates included in this training are no longer accurate.
- With managed care suspended, NC Medicaid will continue to operate under the current fee-for-service model administered by NC DHHS. Nothing will change for Medicaid beneficiaries; they will get health services as they do today. Behavioral health services will continue to be provided by LME-MCOs. All health providers enrolled in Medicaid are still part of the program and will continue to bill the state through NCTracks.
- NC DHHS will not decide on a new launch date until it has program authority within a budget that protects the health and safety of North Carolinians and supports NC DHHS’ ability to provide critical oversight and accountability of managed care.
What is a Standard Plan?
Individuals who are considered to be in the mild-to-moderate range regarding mental health/substance use symptoms and need support for those needs. (See below under “Tailored Plan” to see which services will be under the Standard Plans.)
Four statewide and one regional Standard Plans will operate in North Carolina:
AmeriHealth Caritas North Carolina, Inc.
Sheryl Swanson – BH/IDD Provider Network Consultant – (717) 514-5250
Sheron Rankins – Corporate Director Provider Network Management – (704) 437-4101
Katey Weaver – Corporate Population Health (integrated BH/PH management) – (717) 497-9564
Blue Cross and Blue Shield of North Carolina
Health Blue Network Development – (844) 415-2045
Network Development Representatives are available to assist providers Monday through Friday 8:00am-5:00pm ET.
United Healthcare of North Carolina, Inc. (Optum)
Provider Relations Team main contact for NC:
Amy S. Rice – Director of Behavioral Network Services
[email protected] – (813) 877-6829
Additional links on finding online resources, including how to contact the NC Provider Relations Team, can be found at:
Wellcare of North Carolina, Inc.
Jason A. Young MS – Sr. Manager, National Network Management, Behavioral Health
[email protected] – (813) 206-4056
Claudia Phillips – National Network Management Specialist, BH
[email protected] – (312) 833-2748
Carolina Complete Care (Cumberland County only)
Betsey Hamburger – [email protected] – (919) 719-4161
All providers: approved PHP provider contract templates as of May 31, 2019. Visit this website for information on the contracts that have been approved for the Standard Plans.
What is a Tailored Plan?
North Carolina will launch specialized managed care plans, called BH I/DD Tailored Plans, starting in 2021. These plans are designed for those with significant behavioral health (BH) needs and intellectual/developmental disabilities (I/DDs). BH I/DD Tailored Plans will also serve other special populations, including Innovations and traumatic brain injury (TBI) waiver enrollees and waitlist members. Often this is called the “high risk” population.
These tables show the breakdown of services covered by the Standard Plan (SP), Tailored Plan and both:
The Tailored Plan will be operated by Alliance Health within our catchment area. The NC DHHS website is a great source of information regarding the transformation:
Medicaid Transformation Timeline
- August 2018 – DHHS released Standard Plan RFP
- February 2019 – DHHS awarded Standard Plan contracts
- February 2020 – Standard Plans launch DELAYED
- Mid-year 2020 – Tailored Plan readiness reviews (projected)
Resources and Links
NC Medicaid Provider Playbook – DHHS online resource to assist providers in helping their Medicaid beneficiaries transition smoothly to Medicaid Managed Care. This new Provider Playbook is a collection of information and tools specifically tailored to providers.
- Fact Sheet #1: Medicaid Transformation: Overview
This fact sheet describes what will change for Medicaid beneficiaries, what provider can expect with Medicaid Managed Care, and how they can partner with the Department to support beneficiaries during the transition.
- Fact Sheet #2: Medicaid Transformation: Beneficiary Enrollment and Timelines
This fact sheet covers how health plans are either selected or assigned to beneficiaries, and when enrollment opportunities occur.
- Overview of the Beneficiary Enrollment Experience in NC Medicaid Managed Care for Medicaid Providers
This document gives providers a more detailed look at what beneficiaries will experience over the next few months as they transition to Medicaid Managed Care. In addition to providing details on topics in the Fact Sheets, it includes information on recertification, appeals and grievances, Behavioral Health I/DD Tailored Plans and transition of care.
New resources will be added to the Provider Playbook as they become available. For technical issues identified during open enrollment, please email [email protected] or call (919) 527-7460.
NC Medicaid: County Playbook – DHHS is providing county partners with resources to help Medicaid beneficiaries smoothly transition to managed care. This webpage is the “County Playbook,” a place where general and detailed information will be stored to help support North Carolina’s transformation to Medicaid Managed Care. The County Playbook will grow over time, with new documents added as soon as they are available.
NC DHHS Policy Papers – up-to-date documents outlining policies regarding Medicaid Transformation
Contact your Alliance Provider Network Specialist. Find out your Specialist here.
Questions can be submitted to [email protected]. As Alliance gathers questions there will be a frequently asked question section added to this webpage.