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home : news : news May 13, 2021

4/12/2021 7:55:00 PM
Medicaid Managed Care Is Coming
Most Medicaid recipients will need to enroll beginning March 15th

Lincoln County Dept. of Social Services


It has been talked about for over five years, and at one point, North Carolina was on the verge of moving into a Managed Care program for Medicaid.  Now, the program is about to begin, and those who are Medicaid recipients have choices to make.

Medicaid Transformation will change the way most people receive Medicaid services. In 2015, the NC General Assembly enacted Session Law 2015-245, which directed the Department of Health and Human Services (DHHS) to transition Medicaid and NC Health Choice from fee-for-service to Managed Care.

Under the fee-for-service model, DHHS reimbursed physicians and health care providers based on services provided or procedures ordered. This model will now be known as NC Medicaid Direct. Some people will stay in NC Medicaid Direct. Under Managed Care, the State is contracting with insurance companies, called Prepaid Health Plans or PHPs. These PHPs will be paid a capitated rate, which is a pre-determined set rate per person, to provide health care services. This model is known as NC Medicaid Managed Care. Approximately 1.6 million of the current 2.3 million Medicaid beneficiaries will transition to NC Medicaid Managed Care. 

CHANGES FOR MEDICAID BENEFICIARIES

NC Medicaid Managed Care will bring changes for most Medicaid beneficiaries.
• Medicaid services will be administered and reimbursed by health plans.
• Beneficiaries will be able to choose a health plan and primary care provider (PCP). A new support system will be available to help beneficiaries make a choice.
• Medicaid services will not change, but health plans may offer enhanced services to plan members.
• Medicaid eligibility rules and processes will not change because of Medicaid Transformation.

Local Departments of Social Services (DSS) will have materials to share with beneficiaries about the changes. Current beneficiaries will receive information by mail that outlines actions to be taken, when to take those actions, and who they can contact for assistance.

The Department of Health and Human Services (DHHS) will transition most beneficiaries to NC Medicaid Managed Care statewide on July 1, 2021. Some people will stay in NC Medicaid Direct.  Open enrollment for beneficiaries will begin March 15, 2021 and end May 14, 2021.

The five health plans under NC Medicaid Managed Care are:

  • AmeriHealth Caritas
  • Carolina Complete Health
  • HealthyBlue
  • UnitedHealthcare Community Plan
  • WellCare 

Those eligible for Medicaid can enroll at: https://ncmedicaidplans.gov/  or 1-833-870-5500 (TTY: 1-833-870-5588) Hours of operation: 7am to 8pm Monday – Sunday.

Information on the plans and plan videos are available at : https://www.lincolncounty.org/2391/Medicaid-Transformation

For those who live in Lincoln County, the Lincoln County Department of Social Services will also be hosting an outdoor event on Saturday, May 1st in the DSS parking lot.  All plans have committed to being on-site and the public will have the opportunity to learn more about them and ask questions.  DSS staff will be on hand to control walking traffic in the event area to allow for proper physical distancing.  Masks or face coverings are encouraged.



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