North Carolina Medicaid managed care for people with mental illness and disabilities delayed again

Published 7:50 am Sunday, July 23, 2023

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North Carolina’s planned managed care program for Medicaid enrollees who also need services for behavioral health or intellectual or developmental disabilities is being delayed again by state officials.

The start date for these “tailored plans” that will cover roughly 160,000 people had been last Dec. 1. The state Department of Health and Human Services then pushed back its implementation to April 1, then to this coming Oct. 1.

DHHS announced last Tuesday that it wouldn’t meet the October start date either, but this time didn’t give a new date, saying it was “still to be determined.”

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The department has given several reasons for the delays, including the need to locate enough contract service providers for these beneficiaries and technical challenges for the regional behavioral health organizations already in place that would coordinate the managed care.

While technical matters are improving, gaps remain in provider networks, and getting from state lawmakers the tools needed to carry out well the tailored plans is “still a work in progress,” a DHHS news release said.

This combined with ongoing negotiations at the General Assembly over the state budget, which was supposed to take effect July 1 and includes Medicaid funding, made the open-ended delay necessary, according to the agency.

Expected recipients of tailored plans would have otherwise received notices later this month of the changes, and “the delay will minimize confusion,” DHHS said, adding that the agency remains committed to implementing the plans.

Consumers to participate in tailored plans, including people with traumatic brain injuries, keep receiving care through their existing plans during the delay.

In July 2021, the state moved two-thirds of North Carolina’s then-2.5 million Medicaid recipients from a traditional fee-for-service system to one in which several statewide health plans and one multiregional plan received monthly payments for each patient they enrolled and treated. But such changes were postponed for people with severe disabilities and mental health needs, for whom a complicated array of conventional care and specialized services are needed.

The delay doesn’t directly affect a state law that Democratic Gov. Roy Cooper signed in March that expands Medicaid to hundreds of thousands of low-income adults. But the law says such coverage can’t be implemented unless a state budget law is enacted.

House Speaker Tim Moore said last Tuesday that House and Senate Republicans are still negotiating on a consensus two-year budget “but we are not there yet.” Remaining differences include the extent of future tax cuts and how much revenue will be earmarked for capital projects, Moore told reporters.