August 18, 2021
North Carolina’s move to establish a Medicaid system that provides for integrated, whole person physical and MH/IDD/SUD care as well as opportunities to address non-medical drivers of health/social determinants of health finally began on July 1. It has been a lot of work and a long time coming. In 2016, NC DHHS received approval from the federal government to pursue Medicaid managed care. The NC General Assembly supported this move to create a competitive system that moved the risk for budget shortfalls away from the State.
For many stakeholders within the public health and human services system, the move to Medicaid managed care is not as much about the bottom line as it is about the opportunity to improve coordination, seamlessness and outcomes for the users of the system and their families. To ensure these elements are at the center of our managed care system, NC DHHS leaders have incorporated a number of important components such as Advanced Medical Homes that are responsible for the coordination of an individual’s care, value-based contracts that create reimbursement mechanisms based on measures of performance of the provider and outcomes for the individual, data sharing and integration that gets away from siloed services and promotes a whole person approach, many stakeholders are hoping this becomes a true transformation of the system.
As of July 1, nearly 1.6 million Medicaid eligible individuals are now enrolled with one of the following Standard Plans:
Medicaid members have 90 days to change their Standard Plan without having a cause for that change. For more information about enrollment follow this link.
i2i’s Medicaid Transformation Resources
The i2i Center for Integrative Health has positioned itself to serve as a resource during this shift in Medicaid Transformation and the move to integrated, whole person care.
Just a reminder if you are looking for details on the many policies, service and system elements of Medicaid Managed Care Transformation including, summaries on state policies, the State’s Strategy to ensure Quality Care, consumer involvement, the transition of care, etc., i2i has been writing about and tracking these issues since January, 2018. All Medicaid Transformation articles can be found on our website. In addition, NC DHHS has a detailed Medicaid Transformation website.
i2i’s upcoming conference, December 8-10 in Pinehurst – Opportunity and Optimism – Building Bridges to Tomorrow will offer numerous sessions from state and national experts on Medicaid managed care requirements, service changes and new opportunities for all those providing care, managing services, advocating and receiving care. Look for on line registration to open in mid-September.