Medicaid Transformation

Medicaid Transformation

BH/IDD Tailored Plan Care Management a Work in Progress

March 23, 2021

The care management function under the BH/IDD Tailored Plan (Tailored Plan) appears to be evolving.  The care management function under the Standard Plan and BH/IDD Tailored Plan have significant differences in requirements based on the needs of the members of these plans.  An initial difference is that an Advanced Medical Home under the Standard Plan…

Medicaid Transformation

Transition of Care Further Explained

If you are a consumer or family member, perhaps the most important aspect of this transformation is assurances that moves between plans, providers and emergency services will not be disruptive.  The Transition of Care policy that NC DHHS has published covers the responsibilities of the Prepaid Health Plans (PHPs) in these circumstances: when a Medicaid…

Medicaid Transformation

Foster Care Specialty Plan Postponed

Based on feedback already received, NC DHHS has postponed the Foster Care Specialty Plan (FC Plan) implementation from July 1, 2022 until July 1, 2023.  The Department will establish a Foster Care Plan Workgroup that will support the development of an interim and long-term plan for children in foster care.  Interested individuals/groups should notify the…

Medicaid Transformation

Medicaid Managed Care Consumer Rights Information

February 26, 2021

A free webinar will be held Friday, March 19, 12:00-1:30 PM for health care advocates and other interested parties about NC Medicaid’s Move to Managed Care. Topics will include: How the new system will work and important rollout dates Duties of the state agency, managed care plans, and Enrollment Broker to beneficiaries Anticipated challenges/issues to…


NC DHHS Creates New Medicaid Managed Care Provider Page

February 16, 2021

The new webpage includes important information for Providers as we transition to the Standard Plan between now and July 1. Information includes: Provider Directory Key Dates of Transformation Contracting Information Provider Playbook Updates Upcoming Webinars February – April, 2021 and more.

Medicaid Transformation

Ombudsman Contract Awarded to Legal Aid of North Carolina

February 2, 2021

NC DHHS announced that they have awarded the Ombudsman contract for Medicaid managed care to Legal Aid of North Carolina.  The Ombudsman role is a federally mandated component of the 1115 Medicaid waiver that gives NC the authority to move forward with integrated Medicaid managed care.  In 2018, i2i wrote about the ombudsman in 2018…

Medicaid Transformation

RFA for BH/IDD Tailored Plan – What You Need to Know

December 16, 2020

A key indicator that Medicaid Transformation is back is the recent publication of the Request for Application (RFA) for the BH/IDD Tailored Plan.  The Tailored Plan is scheduled to go-live on July 1, 2022, one year after the Standard Plan is implemented.  And with all of the requirements in the RFA for physical health, it…

Medicaid Transformation

Medicaid Transformation Timelines Set

NC DHHS Secretary for Medicaid Dave Richard recently spoke to the Medical Care Advisory Committee on December 11th about the commitment of the Department to move forward with Medicaid Managed Care Implementation.  Richard characterized the move to managed care in Medicaid as the means to meet the larger priorities of the State, i.e. value-based care…