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Medicaid Transformation

The way you receive Medicaid services in North Carolina is changing. Under the current system, Medicaid services for behavioral health and intellectual and developmental disabilities (I/DD) are managed by LME/MCOs like Partners Health Management. Physical health and pharmacy services are managed by the North Carolina Department of Health and Human Services under a fee-for-service model (NC Medicaid Direct).

What’s Happening?

On July 1, 2021, North Carolina began transitioning to a Medicaid Managed Care model. This model combines services for behavioral health, I/DD, physical health and pharmacy under one plan. You will still be able to receive your same Medicaid services, but they will be managed under one of two types of health plans: Standard Plans, which launched July 1, 2021, or Behavioral Health Intellectual/Development Disability Tailored Plans (Tailored Plan), which will launch December 1, 2022.

Both Standard Plans and Tailored Plans will integrate physical health, behavioral health and pharmacy services. Most people receiving Medicaid services will move to a Standard Plan. Partners will continue to serve members with significant behavioral health disorders, I/DD and traumatic brain injuries under NC Medicaid Direct until the Tailored Plans launch in December 2022.

Standard Plans will serve most Medicaid and NC Health Choice members, including all adults and children and those with mild to moderate behavioral health needs.

Tailored Plans will serve individuals with significant behavioral health disorders, I/DD and traumatic brain injuries. The Tailored Plans also will serve individuals who currently receive state-funded services.

For more information about Medicaid eligibility and Medicaid Transformation, call the NC Medicaid Contact Center at 1-888-245-0179.

(Updated December 10, 2021)

On July 1, 2021, many Medicaid members began receiving care through NC Medicaid Managed Care (Standard Plans or the Eastern Band of Cherokee Indians Tribal Option). Some individuals receiving specialized services remained in NC Medicaid Direct and their care is managed by LME/MCOs like Partners. For example, if you currently receive services under the NC Innovations Waiver, you will continue to have your services managed by Partners.

All individuals moving to NC Medicaid Managed Care were enrolled in one of the plans by either selecting a health plan during open enrollment or through the auto-enrollment process. In June, individuals were mailed welcome packets with information from their health plan and new Medicaid ID cards. Individuals have until Sept. 30, 2021, to change plans for any reason.

Individuals receiving care through a Standard Plan have several resources to help answer questions about their transition to NC Medicaid Managed Care. Those who want a reminder of which health plan they are enrolled in should call the Enrollment Broker at 833-870-5500 (TTY: 711). Questions about benefits and coverage can be answered by calling their health plan at the number listed in the welcome packet or on the What Beneficiaries Need to Know on Day One fact sheet. For other questions, beneficiaries can call the NC Medicaid Contact Center at 888-245-0179 or visit the Beneficiaries section of the Medicaid website.

If you were eligible to join a Standard Plan, you should have received a letter from NC Medicaid. Letters were mailed to Medicaid beneficiaries in March. Standard Plan Open Enrollment began on March 15, 2021 and closed on May 21. (Read the May 18, 2021 NCDHHS press release to learn more.)

All Medicaid recipients were required to confirm enrollment in a Standard Plan or remain in NC Medicaid Direct and receive behavioral health and I/DD services through an LME/MCO. You were also required to select a primary care physician.

Standard Plans are being provided by the following insurance companies:

  • Carolina Complete Health*
  • AmeriHealth Caritas
  • Healthy Blue
  • WellCare
  • UnitedHealthcare Community Plan
  • EBCI Tribal Option**

You can compare health plans on this webpage to help with your choice https://ncmedicaidplans.gov/find/viewhealthplans

An Enrollment Broker can help you decide which plan you should choose; they also can help you select a primary care provider. To contact an Enrollment Broker, call toll free 1-833-870-5500.

If you are placed in a Standard Plan but feel you should be served by a Tailored Plan, you may request to be switched to your LME/MCO and continue receiving services under NC Medicaid Direct until the Tailored Plan launches. Notification letters include instructions on how to move from one plan to another. You may also contact an Enrollment Broker for assistance.

Members who use certain services for their intellectual or developmental disability, mental health needs, traumatic brain injury or substance use disorder may ask to be served through a Tailored Plan. Examples of these services are (b)(3) services, State-funded Services, individuals on the Registry of Unmet Needs (Innovations waiting list).

All Medicaid recipients can find more help about Medicaid Transformation on the Medicaid enrollment website or by calling 1-833-870-5500.

 

IMPORTANT DATES
March 15, 2021 Open enrollment begins for Standard Plans
May 21, 2021 Open enrollment ends for Standard Plans
May 21, 2021 Auto-enrollment occurs for beneficiaries who have not selected a health plan
May 22, 2021 (est.)
Transition of Care information is sent to the health plans for their beneficiaries
July 1, 2021 Standard Plans launch
July 26, 2021 NCDHHS awards  Tailored Plan contracts
December 1, 2022 Tailored Plans launch

 

*Carolina Complete Health is only available to beneficiaries in these counties: Alamance, Alexander, Anson, Bladen, Brunswick, Cabarrus, Caswell, Catawba, Chatham, Cleveland, Columbus, Cumberland, Durham, Franklin, Gaston, Granville, Harnett, Hoke, Iredell, Johnston, Lee, Lincoln, Mecklenburg. Montgomery, Moore, Nash, New Hanover, Orange, Pender, Person, Richmond, Robeson, Rowan, Sampson, Scotland, Stanly, Union, Vance, Wake, Warren and Wilson.

**The EBCI Tribal Option is only available to federally recognized tribal members or others eligible for Indian Health Services (IHS) who live in Cherokee, Graham, Haywood, Jackson or Swain counties. Eligible members in the following counties may opt in: Buncombe, Clay, Henderson, Macon, Madison and Transylvania.

NC Medicaid created a Provider Playbook as an online resource for providers delivering services to Medicaid beneficiaries. The playbook includes information like Beneficiary Materials, Fact Sheets, Frequently Asked Questions, Training Courses and Trending Topics.

Partners will work with NC DHHS to develop training for providers. Training opportunities will be shared on the Event Calendar and in the Provider Communication Bulletin

Providers may contract with health plans at any time, but in order for the provider’s information to be included in auto-enrollment, contracts need to be in place by April 12, 2021. Processing is typically two to three weeks.

If you are a provider who accepts Medicaid, you will continue to bill the state through NCTracks. Providers currently contracted with Partners may also need to contract with a Standard Plan. If you are serving members who join a Standard Plan, you will no longer be able to bill Partners for Medicaid services.

July 20, 2021 Transition of Care FAQs (PDF)

July 2021 Transition of Care FAQs (PDF)

June 2021 Transition of Care FAQs (PDF)

Partners Training Academy

Transitioning to AlphaMCS

NCDHHS Transition of Care Data Transfer:
Processes Impacted by 42 CFR Part 2 (May 24, 2021)
Presentation
Recording

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