Medicaid Transformation

Medicaid Transformation Begins as Open Enrollment Goes Live

March 23, 2021

Moving to Medicaid managed care has been a roller coaster ride in North Carolina.  There have been budget impasses, postponements and lawsuits.  All of those challenges seem to have been overcome.  The money has been appropriated to get started.  Standard Plan members are currently in an open enrollment period to choose their Prepaid Health Plans…

Medicaid Transformation

BH/IDD Tailored Plan Care Management a Work in Progress

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…


NC General Assembly Allocates New COVID-19 Funding

Two bills have been signed into law that allocate federal COVID-19 funding and appropriate additional funding to address the pandemic in communities.  The most recent bill, SL 2021-3:  2021 COVID-19 Response and Relief was signed into law by the Governor on March 11th.  Some of the provisions include: For the Community Mental Health Block Grant:…

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…


American Rescue Plan Includes BH/SUD/IDD Funding

Congress passed the HR 1319, the American Rescue Plan Act of 2021, and it did include funding for mental health and substance use disorder services as well as home and community based services. Some of the largest allocations for BH/IDD in the American Rescue Plan include: • $1,500,000,000 in funding for block grants for community…

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.