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North Carolina Medicaid to Transition to Managed Care Beginning in 2019

On February 4, 2019 the North Carolina Department of Health and Human Services announced the selection of Prepaid Health Plans that will participate in Medicaid Managed Care.  The move from a traditional, State run Medicaid program, to a managed care model has been in the works since 2015 when the General Assembly directed the transition of Medicaid to the managed care structure.  The State Department of Health and Human Services will continue to oversee all aspects of the Medicaid and NC Health Choice Programs.  These Prepaid Health Plans, however, will directly manage certain health services, assume financial risk and contract with providers to deliver services for beneficiaries.  This is all according to the NC Medicaid bulletin found here.

Statewide contracts were awarded to the following carriers: AmeriHealth Caritas North Carolina, Inc., BCBS of North Carolina, United Healthcare of North Carolina, Inc., and WellCare of North Carolina.  There were also 2 regional contracts awarded to Carolina Complete Healthcare, in regions 3 and 5 found on this map

The Medicaid Managed Care plans will launch in 2 phases.  The first will launch in November 2019 for beneficiaries in 27 counties.  The remaining counties will launch in February 2020.  It is also important to note that this change to managed care is only on “Standard Plans,” which represent about 1.6 million Medicaid members.  Tailored plans, such as those with specialized coverage for behavioral health needs, will be procured at a later date.

APS has begun working to enroll all clients with these Medicaid Managed Care plans in order to avoid denial issues once they launch. 

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