July 8, 2019

Medicaid Transformation Hits Milestone

June 28th marked another milestone for Medicaid Transformation when the NC Enrollment Broker website went live.  Medicaid beneficiaries can now go to ncmedicaidplans.gov to find out much more about the move to Medicaid and Health Choice managed care.  The NC Enrollment Broker is responsible for education and outreach to Medicaid and Health Choice beneficiaries on the plans and benefits available to each individual.  It is their responsibility to work with the beneficiary to find the plan that best fits the needs of that individual.  The NC Enrollment Broker is offering multiple ways for beneficiaries to learn more about their options under managed care including the website, toll-free number, chat line, mobile app and education events across the state.  The NC Enrollment Broker role has been contracted out to Maximus. 

Initially, it was planned that letters would be sent to beneficiaries simultaneous to the go live of the website.  These letters would inform individuals about their future Medicaid and Health Choice benefit plan.  The mailing of the letters has been postponed due to some legislative activity that may delay the implementation of Medicaid Transformation (see below for more information).  When the letters do go out some individuals may receive a letter indicating that they are eligible for the Standard Plan.  Many individuals who have previously been receiving mental health and substance use disorder services that are locally managed by LME/MCOs will be notified that their services will be managed by one of the statewide Prepaid Health Plans (PHPs) or the one regional PHP that will offer the Standard Plans.  Those individuals will tap into the assistance of the NC Enrollment Broker sooner rather than later as the open enrollment process, based on the region in which you reside, begins as early as July 15th for individuals who reside in Regions 2 and 4 (see map of regions).  Other individuals will be notified that they will remain with the LME/MCOs for their behavioral health services and will also continue receiving their physical healthcare services with no change in process – remaining in a fee-for-service arrangement for care.  Individuals with intellectual or developmental disabilities (I/DD) who are in the NC Innovations Waiver will NOT receive a letter.  But beneficiaries who are waiting for an open slot on the NC Innovations Waiver will receive a letter and have the option to join the Standard Plan while they remain on the waiting list. 

“Raise Your Hand” Option Will Be Available for Beneficiaries

If a Medicaid or Health Choice beneficiary receives a letter indicating that he/she will be in the Standard Plan and that beneficiary believes he/she should have access to the services package only available through the LME/MCOs, that beneficiary has the option to “raise your hand” and request that NC DHHS re-evaluate their eligibility.  The form that the beneficiary will use has not yet been finalized.  To their credit, NC DHHS is taking their time to ensure that there has been input provided by stakeholders across the system on the development of this form.  In fact, the i2i Center has been involved in the feedback forums.  Many comments have been centered around ensuring that the form is easy to complete and easily accessible.  There has been concern expressed that those beneficiaries who are currently in services only available through the LME/MCOs will go to their provider and LME/MCO for help.  The expectation of NC DHHS is that the NC Enrollment Broker will provide that assistance. 

Legislature Proposes a Medicaid Transformation Delay

A bill that was previously introduced in this legislative session, has been amended to include a potential delay of the Medicaid and Health Choice move to managed care.  Section 7 of S212, states, “If House Bill 966, 2019 Regular Session, does not become law by July 15, 2019, then the Department of Health and Human Services shall delay, until at least March 1, 2020, the implementation of the Medicaid and NC Health Choice transformation required by S.L. 2015-245, as amended, and by the 1115 demonstration waiver.” H966 is the 2019 budget bill that has been vetoed by the Governor.  The vetoed budget bill is scheduled to be considered by the House on July 8th.  If the veto remains in place, it may be beyond July 15th when the budget is signed into law.  S212 has passed the Senate and the House Health Committee and is currently in the House Rules Committee.  It is important to keep in mind that S212 would also have to be signed into law for this provision to be effective.  That reduces the chances of this legislated delay becoming a reality. 

NC DHHS has planned for a staggered start to Medicaid and Health Choice managed care that would begin November 1, 2019 for Regions 2 and 4 with all other regions coming under managed care on February 1, 2020.  NC DHHS is moving forward with the implementation as planned unless there is legislative direction to delay. 

Legal Challenge to Medicaid Contracts Denied

Another obstacle for the implementation of Medicaid transformation was a legal challenge by the organizations not chosen as PHPs for Medicaid managed care.  This was settled in a June 26th ruling by Administrative Law Judge Tenisha Jacobs.  The judgement denied a preliminary injunction request from Aetna Better Health, Optima and My Health by Health Providers, a provider-led coalition of a dozen hospitals around the state and ruled in favor of the N.C. Department of Health and Human Services.  The judge did not agree with the plaintiff’s assertion that the process for choosing of the statewide PHPs was done in bad faith, unfair or lacked careful consideration.  The plaintiffs can continue to pursue their case if they choose, but it is thought that with this order it is not likely they will be successful.  Learn more about the ruling.