Six years after approval, North Carolina is making the switch to Medicaid Managed Care
Nearly 1.6 million Medicaid beneficiaries in North Carolina will begin receiving the same Medicaid services in a new way — through NC Medicaid Managed Care health plans. Most beneficiaries will continue to get care from the same doctors they currently see, but will now be a member of a health plan.
The switch begins Wednesday, July 1, 2021. Some beneficiaries will not enroll with health plans, and will remain in NC Medicaid Direct.
According to the North Carolina Department of Health and Human Services (NCDHHS), features of the state’s program include establishing a payment structure that rewards better health outcomes, integrating physical and behavioral health, and investing in non-medical interventions aimed at reducing costs and improving health.
Since the passage of legislation in 2015 that began the state’s transition to managed care, NCDHHS has worked with health plans, providers, beneficiaries, and community-based organizations to design and prepare for implementation.
"As our role shifts to provide regulatory oversight, we expect on Day One that people get the care they need and providers get paid," said Deputy Secretary of NC Medicaid Dave Richard. "We also anticipate that health plans will quickly address any bumps in the road as we work together to implement the largest change in NC Medicaid’s history."
Under managed care, Medicaid providers enroll with one or more health plan networks. To support a smooth transition of care for beneficiaries and providers, health plans will honor approvals beneficiaries have already received for care for the first 90 days after July 1 if those services are also covered by the plan.
Health plans will also pay providers who may be outside their network at the same rate as their own providers for the first 60 days after launch.
All beneficiaries moving to NC Medicaid Managed Care were enrolled in one of five health plans or the Eastern Band of Cherokee Indians (EBCI) Tribal Option. That was by either selecting a health plan during open enrollment, or through the auto-enrollment process.
Starting in June 2021, beneficiaries were mailed welcome packets with information from their health plan and new Medicaid ID cards.
Beneficiaries have until Sept. 30, 2021, to change plans for any reason.
Get more information
Beneficiaries have several resources to help answer questions about their transition to NC Medicaid Managed Care. Those who want a reminder of which health plan they are enrolled in should call the Enrollment Broker at 833-870-5500 (TTY: 833-870-5588).
Questions about benefits and coverage can be answered by calling the health plan at the number listed in the welcome packet or on the What Beneficiaries Need to Know on Day One fact sheet.
For other questions, beneficiaries can call the NC Medicaid Contact Center at 888-245-0179 or visit the “Beneficiaries” section of the Medicaid website.
Additionally, for issues that cannot be resolved with their health plans, beneficiaries can contact the NC Medicaid Ombudsman at 877-201-3750.
More information on Medicaid Managed Care can be found on the NC Medicaid website at medicaid.ncdhhs.gov/transformation.