Medicaid Managed Care rolling out in North Carolina

Published 7:39 am Thursday, March 18, 2021

North Carolina is rolling out a Medicaid Managed Care program.

Open enrollment started Monday, March 15 and runs through May 14.

The North Carolina Department of Health and Human Services has started mailing enrollment packets statewide.

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Medicaid beneficiaries can call the Medicaid Enrollment Call Center at 833-870-5500 (TTY: 833-870-5588) or visit the Medicaid enrollment website at ncmedicaidplans.gov for detailed information.

In eastern North Carolina, four companies are offering standard plans: WellCare of NC, Inc., United Health Care of NC Inc., Blue Cross Blue Shield of NC and Amerihealth Caritas NC, Inc. A fifth company is offering a standard plan in three of the regions, but not in eastern North Carolina.

On May 15, if a Medicaid beneficiary has not made a selection, the patient will be automatically assigned to one of four plans. NC Medicaid Managed Care starts July 1, 2021.

On Monday, March 1, Dave Peterson, senior regional director with Trillium Health Resources, briefed the Dare County Board of Commissioners on what Medicaid Managed Care will bring to the 26-county region. In the Trillium service area, 266,000 people are Medicaid eligible.

Peterson reports that those with low or mild and moderate behavioral health needs will move to the Medicaid Managed Care system. Low was described as those needing monthly prescription for depression or basic outpatient therapy. Peterson described moderate as those receiving weekly outpatient therapy and medication.

Under the new system, Trillium has applied for a tailored plan to manage the high risk/high cost individuals with mental health, developmental disabilities and substance use issues. This high risk group represents about 25% of current Trillium cases. Under the tailored plan, Trillium will be managing the whole person, both physical and behavioral health.

For Trillium, the transformation to Medicaid Managed Care means contracts with every primary care provider who accepts Medicaid and 2,100 pharmacies in the region.

Trillium will hear from the state June 11 if its tailored plan will be accepted.

The start date for tailored plans in North Carolina is July 1, 2022.

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