Medicaid Transformation

Medicaid Transformation

NC Design for State Funded Services under the Tailored Plan

January 14, 2020

While the implementation of managed care has been suspended as legislative action is needed to move forward, the Department continues to work on the design of Tailored Plans to serve individuals with behavioral health and intellectual disabilities in lieu of Standard Plans. In addition to managing Medicaid services, Behavioral Health I/DD Tailored Plans also will be…

Medicaid Transformation

Policy on Medicaid Accountable Care Organizations for the Medicaid Standard Plan and Providers

This paper released on January 8th, provides details on an optional Medicaid ACO program, including ACO organizational requirements, payment parameters, total cost of care calculation and participation incentives for early adopters. PHPs and providers can form ACO arrangements as a way to promote value in Medicaid and meet the Department’s VBP targets. The Department welcomes…

Medicaid Transformation

Policy on Value Based Payment Strategy for Medicaid Managed Care

This paper (released January 8th) describes the vision for value-based payments between Prepaid Health Plans and providers in NC Medicaid Managed Care. The Department welcomes feedback on this paper at by Feb. 19, 2020. i2i is developing a Medicaid Transformation summary document on this information.

Medicaid Transformation

Update on Medicaid Transformation

November 21, 2019

On November 19th, NC DHHS released a statement that Medicaid Transformation has been suspended until the budget impasse is resolved.  A few points related to the suspension: There is NO IMPACT on Medicaid beneficiaries and their services.  All services will continue to be provided as they have been. Open enrollment is also suspended.  This means…

Medicaid Transformation

Data Strategy for BH/IDD Tailored Plan Care Management

November 11, 2019

The ability to share data is one of the most important capacities that the State, payers and providers must demonstrate to thrive in the future.  To take it a little further, some would say that the care manager is at the hub of data sharing.  The care manager is responsible for assessing, monitoring and coordinating…

Medicaid Transformation

Carolina Complete Health Awarded Additional Region in Medicaid Managed Care

October 8, 2019

The North Carolina Department of Health and Human Services (DHHS) has expanded the regions awarded to Carolina Complete Health, Inc. to serve as a prepaid health plan under the state’s transition to Medicaid managed care. In addition to serving regions 3 and 5 in the state, the provider-led health plan will also serve region 4….

Medicaid Transformation

Community Support Team Service Changes Lead to Whole Person Care

September 16, 2019

Community Support Team is both a Medicaid and State-funded service definition that offers adults with mental illness and/or substance use disorders a structured team approach to increase and restore the individual’s ability to live successfully in the community.  The service definition is undergoing a rework that will fold in parts of another service definition, Transition…