In 2015, the NC General Assembly enacted legislation directing DHHS to transition 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 enrolled person to provide all services. The Department was on track to go live February 1, 2020; however, new funding and program authority were required from the General Assembly to meet this timeline and Medicaid Managed Care was suspended in November 2019. In July 2020, legislation authorized the restart of Medicaid Managed Care transformation efforts with a July 1, 2021 launch date for Standard Plans and a July 1, 2022 launch date for Behavioral Health I/DD Tailored Plans.
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Medicaid Transformation Resources
What is a Standard Plan?
There are six health plan contracts, five prepaid health plans and one primary care case management entity, to deliver Standard Plan Medicaid services starting July 1, 2021, to eligible North Carolina beneficiaries.
AmeriHealth Caritas of North Carolina – Prepaid Health Plan; Statewide
Blue Cross and Blue Shield of North Carolina – Prepaid Health Plan; Statewide
UnitedHealthcare of North Carolina – Prepaid Health Plan; Statewide
WellCare of North Carolina – Prepaid Health Plan, Statewide
Carolina Complete Health, Inc. – Prepaid Health Plan, Regions 3, 4 and 5
Eastern Band of Cherokee Indians (EBCI) Tribal Option – Primary Care Case Management managed by the Cherokee Indian Hospital Authority. For federally recognized Tribal members and others eligible for services through the federal Indian Health Service agency.
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.