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NC Medicaid Reform

Health Centers: Preparing for Medicaid Managed Care

April 2019:

Review Medicaid Enrollment Records in NCTracks in Advance of Managed Care

To ease the burden on credentialing with multiple Medicaid managed care plans, the NC Department of Health and Human Services selected a provider data contractor (PDC) – Wipro Infocrossing – to serve as the state’s centralized credentialing provider. Neither the PDC nor Medicaid prepaid health plans/managed care plans are permitted to reach out to providers to update credentialing information (this is meant to ease the burden on providers). Therefore, it is imperative that Medicaid providers keep their information up to date in NCTracks. As outlined in the NC Medicaid April bulletin, be sure to:

  • Review affiliations by location for accuracy
  • End-date any affiliations that are not current
  • Make sure physical addresses are correct with the accurate taxonomies
  • Review license, certification, and accreditation information
  • If necessary, begin the Managed Change Request process to make necessary corrections and updates

Consumers: Preparing for Medicaid Managed Care

NCCHCA and Community Health Center staff collaborated to develop the following template resource for community health centers to modify and share with their Medicaid consumers:

NC Medicaid Transformation: The Basics

The proposed “Medicaid Transformation” plan will move most of NC Medicaid’s services for adults and children into a managed care model, such that:

  • Beneficiaries will select or be assigned to a Prepaid Health Plan which will offer a “Standard Plan” through which beneficiaries will access health care services from the company’s network of providers.


  • Providers will contract with Standard Plans to serve Medicaid beneficiaries through Plan networks and will bill Plans for those services
  • NC DHHS will pay Standard Plans a set rate for each beneficiary that elects into/is assigned to the Standard Plan, and Standard Plans will have to managed beneficiary health care costs within that provided amount

I.                    Resources

Full Timeline

NC Medicaid Transformation Timeline

1115 Waiver Demonstration: Jan 1, 2019 – October 31, 2024


2018, August 9 – NC DHHS releases Request for Proposals (RFP) with details for entities bidding for Prepaid Health Plan (PHP) awards

2018, August 23 to October 4 – Advanced Medical Home (AMH) trainings for primary care providers

2018, October 19 – RFP Proposals due to NC Department of Health and Human Services from entities wanting a Medicaid managed care contract

2018, October 24 NC DHHS receives Waiver approval from the Centers for Medicare and Medicaid Services, allowing Medicaid managed care transformation to move forward

2019, January 31 Deadline for primary care providers to attest as Tier 3 Advanced Medical Home providers. Only those attesting by this date were included in the lists of AMH Tier 3s given to PHPs for contracting.

2019, early – Request for Information to inform development of Healthy Opportunities (social determinants of health pilots) in 2-4 regions

2019, February 4NC DHHS announces PHP and PLE contract awards

o   Statewide Standard Plans: AmeriHealth Caritas North Carolina, Inc., Blue Cross and Blue Shield of North Carolina, UnitedHealthcare of North Carolina, Inc., WellCare of North Carolina, Inc

o   Regional Standard Plan: Carolina Complete Health (Regions 3 & 5)

2019, February to May Contracting period for PHPs to identify and contract with network providers

2019 Summer – Contracted PHPs must have adequate service networks completed

·   Request for Proposals for Healthy Opportunities pilots in 2-4 regions

2019, July 15 to September 13 Phase 1 Standard Plan Open Enrollment begins. Beneficiaries Regions 2 & 4 select PHP network and primary care provider

2019, November 1 Phase 1 of Medicaid Managed Care Standard Plans begins in two regions

2019, October 10 to December 13 Phase 2 Standard Plan Open Enrollment. Beneficiaries in Regions 1, 3, 5, 6 select plans.

2019, late – NC DHHS awards Healthy Opportunities pilots

2020, February 1 Medicaid managed care will launch in Phase 2 regions

·         DHHS releases BH I/DD Tailored Plan Request for Award (tentative)

2020, May – NC DHHS awards BH I/DD Tailored Plan contracts (tentative)

2020, June 30 – End of Standard Plan Contract Year 1

2021, January – Healthy Opportunities pilot begins

2021, July 1 – Tailored Plans begin

2022, June 30 – End of first Standard Plan contract awards

2024, October 31 – Healthy Opportunities pilot ends


Archived News

February 4, 2019: NC Medicaid Awards Standard Plans for NC Medicaid Transformation

On February 4th, the North Carolina Department of Health and Human Services (DHHS) announced Standard Plan awardees for the state’s Medicaid transition from an enhanced primary care case management model to a managed care model using pre-paid health plans to focus on contracting for whole person services.
Statewide Awarded Standard Plans:

  • AmeriHealth Caritas North Carolina
  • Inc. Blue Cross and Blue Shield of North Carolina
  • UnitedHealthcare of North Carolina, Inc.
  • WellCare of North Carolina, Inc.

One Regional Awarded Standard Plan

  • Carolina Complete Health (Regions 3 and 5)

NC DHHS also announced regions 2 and 4 will be in phase 1 of rollout which will begin November 1, 2019. The remaining regions will be rolled out February 3, 2020. NC FQHCs are considered essential providers and are expected to be offered good-faith contracts with all plans

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