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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 will begin 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 launch July 1, 2021, or Behavioral Health Intellectual/Development Disability Tailored Plans (BH I/DD Tailored Plan), which launch July 1, 2022.

 

Both Standard Plans and BH I/DD 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 BH I/DD Tailored Plans launch in July 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.

 

BH I/DD Tailored Plans will serve individuals with significant behavioral health disorders, I/DD and traumatic brain injuries. The BH I/DD 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.

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