Medicaid Transformation Updates

Open enrollment for Medicaid Managed Care is underway!

Since most Medicaid beneficiaries will receive Medicaid services through health plans under managed care it is important they choose a health plan by May 14, 2021. Beneficiaries that do not choose a plan by May 14 will have a plan chosen for them.

Please join NC DHHS for a webinar to hear the latest updates in the state’s transition to Medicaid Managed Care including an overview of auto-enrollment and how it works. There will also be an opportunity for questions and answers.

Register for the Community Partners Webinar:

Next steps in NC Medicaid’s Transition to Managed Care 2-3 p.m., April 21, 2021

Quality Strategy Update Draft Posted for Public Comment

From DHHS:

Monday, April 5, 2021

On April 5, 2021, the Department of Health and Human Services posted the updated draft of NC Medicaid’s Managed Care Quality Strategy for public comments until May 6, 2021. 

The strategy details the Department’s goals to improve the health of North Carolinians through an innovative, whole-person centered and well-coordinated system of care and measurement of quality, which addresses both medical and non-medical drivers of health. The Department’s Quality Strategy details Medicaid Managed Care aims, goals and objectives for quality management and improvement and details specific quality improvement (QI) initiatives that are priorities for the Department. 

The updated Quality Strategy now incorporates the quality activities of all managed care plans, including the Behavioral Health I/DD Tailored Plans, the Eastern Band of Cherokee Indians (EBCI) Tribal Option and Community Care of North Carolina.  

The North Carolina Medicaid Managed Care Quality Strategy update draft is available on the Quality Management and Improvement webpage. To comment on the strategy, please email Medicaid.NCEngagement@dhhs.nc.gov.

NC DHHS Fact Sheets

NC DHHS has added a number of helpful fact sheets to support providers during the transition to NC Medicaid Managed Care. 

For example:

For a full collection of NC DHHS Fact Sheets and other resources, visit the NC Provider Playbook

Medicaid Managed Care Back Porch Chat Webinar Series 

Back Porch Chats (formerly Fireside Chats) will continue taking place every first Thursday of the month from 5:30-6:30PM. Hosted by Shannon Dowler, MD, Chief Medical Officer, NC Division of Health Benefits and moderated by moderated by Hugh Tilson, Director, NC AHEC Program.

Back Porch Chats cover a range of Medicaid Managed Care Topics and are great sources of information for all provider types!

For more information and to register, visit the NC AHEC Medicaid Managed Care webpage

AHEC to Host Virtual PHP Meet and Greets

The NC Medicaid Provider Services team is partnering with NC AHEC to host virtual Health Plan Meet and Greet sessions. NC Medicaid consultants and health plan representatives will be available to address your concerns and questions about the transition from Medicaid fee-for-service to Medicaid Managed Care.

Virtual Meet and Greet sessions are structured as conversations between providers and Managed Care Health Plan staff with a Q&A for participants. Sessions will be delivered live with a recording and transcript made available on this page after each event. Feel free to drop in at any time during the sessions below.

  • MARCH 23 & APRIL 6: Primary Care & Specialty Providers
  • MARCH 24 & APRIL 7: Long Term Services & Supports
  • MARCH 25 & APRIL 8: Behavioral Health Providers 

Visit NC AHEC for full information and to register

As a Tier 3 Advanced Medical Home, you may be eligible to receive $8.51 PMPM beginning in April. Allow us to help you! We don't want you to leave any money on the table

AMH Tier 3s may be eligible to receive $8.51 PMPM from NC DHHS beginning in April. ​

To receive the glidepath payment, a practice must attest to meeting the following requirements in NCTracks:​

  1. Successfully completed NCTracks attestation as an AMH TIer 3​
  2. Completed contracting at a Tier 3 level with at least two PHPs​
  3. Undergone successful data exchange with at least two health plans

Your Provider Engagement team is here to help! Reach out to your Provider Engagement Coordinator(PDF) to get set up for AMH testing that will help you meet requirement #3 above.

To receive AMH Tier 3 glidepath payment for each month, practices must complete attestation before the deadlines lists below:​

  • For payment in April, May, and June, complete before 5PM March 30​
  • For payment in May and June, complete before 5PM on April 27​
  • For payment in June, complete before 5PM on May 27​

For a full description of eligibility and testing criteria, see the March 8th Medicaid Update

Open Enrollment Begins Monday, March 15th

Beginning Monday, March 15, Medicaid beneficiaries are able to enroll into Medicaid managed care health plans. Last week, NC DHHS began mailing enrollment packets statewide and launched the NC Medicaid Enrollment Call Center and a mobile app called NC Medicaid Managed Care. 

Beneficiaries can reach the NC Medicaid Enrollment Call Center at 833-870-5500 (TTY: 833-870-5588) or download the app on Google Play or the App Store. 

The NC Medicaid enrollment website is also a resource for members to select a health plan. 

The next important milestone for providers it to ensure they execute a contract before April 12th, so you are included in the period of auto-enrollment, beginning May 15. 

Access the NC DHHS Provider Playbooks to read more about each milestone in the transition to Medicaid manged care.

Statewide Specialized Foster Care Plan Delayed 

NC DHHS, after careful consideration and review of recommendations from stakeholders, is postponing the launch of the Foster Care Plan until July 1, 2023. This delay will allow time for additional design of and input on the key features of the FC Plan for children and youth currently and formerly involved in the child welfare system.

Individuals in Foster Care will continue to receive services through Medicaid Direct and the LME-MCO behavioral health system.

If you would like to participate in the Department's Foster Care Plan Workgroup to support the interim and long-term plan for children in foster care, you should email Medicaid.NCEngagement@dhhs.nc.gov

This notification was distributed in the March 5 NCTracks Update.

For more information and latest updates, visit the NC DHHS Specialized Foster Care Plan webpage

NCDHHS Released Transition of Care Policy

Consistent with federal requirements and NC Medicaid’s vision to ensure continuity of care for members transitioning between prepaid health plans (PHPs) or service delivery systems, NC Medicaid has released the NCDHHS Transition of Care Policy. The draft policy was released for public comment in February 2020 and finalized on February 25, 2021.

NC Medicaid will host a webinar overview of the Transition of Care Policy on Thursday, March 11, 2021, from 12 noon to 1 p.m. Please pre-register for the webinar

For questions about the Transition of Care Policy, please email Medicaid.NCEngagement@dhhs.nc.gov.

NC DHHS and NC AHEC Office Hours to Launch on March 2

The state will transition to Medicaid managed care as of July 1, 2021 and to help practices prepare for this change, Medicaid Transformation Provider Services and North Carolina AHEC are conducting a series of Virtual Office Hours for those who serve Medicaid beneficiaries beginning in March 2021. These sessions offer an interactive format to have your questions answered on a range of topics related to Medicaid Managed Care. Providers are encouraged to submit questions in advance to Medicaid.virtualofficehours@dhhs.nc.gov for discussion. Virtual Office Hours will cover a range of Medicaid Managed Care topics

The first session was held on Tuesday, March 2 at 4 p.m. with a focus on the Medicaid Provider Directory. The presenter was Christina Bunch, Associate Director of Provider Operations, NC Medicaid Transformation, NC Department of Health and Human Services. View the recording

AMH Provider Manual 2.0 Released

A Message from NCTracks on Behalf of NC Medicaid:The Department recently released the Advanced Medical Home (AMH) Provider Manual 2..0 (PDF). This version reflects program expectations as well as recent program modifications and changes that impact provider contracts. It replaces the prior version issued on December 12, 2019. Additional guidance and program information are available on the Advanced Medical Home webpage.

NC Medicaid Managed Care County Playbook Updates

The following materials have been added to the NC Medicaid Managed Care County Playbook and are available for review. 

DSS Role in Managed Care:

North Carolina's Specialized Foster Care Plan

On July 1, 2022, the Department of Health and Human Services will launch the statewide Specialized Foster Care Plan. This specialized plan is intended to meet the unique needs of North Carolina children and youth currently and formerly involved in the child welfare system and to address receiving seamless, integrated, and coordinated health care.

The Foster Care Plan will integrate comprehensive physical and behavioral health services while maintaining treatment plans when placements change. This plan will also include care management services to improve coordination among service providers, families, involved entities (such as the Department of Social Services, Division of Juvenile Justice, schools) and other stakeholders involved in serving Foster Care Plan members. 

To access the white paper on North Carolina's Specialized Foster Care Plan or to view a recent webinar providing an overview of this plan, visit the DHHS website for the Specialized Foster Care Plan

Next Steps to Prepare for Transformation

  1. Complete contracting by February 1, 2021 for inclusion in open-enrollment*
  2. Review NCTracks to confirm your individual and provider level information is accurate
  3. On January 25th, check the new NC Provider & Health Plan Look-Up tool 
  4. Educate your members about open enrollment and the plans you are contracted with
  5. Access NC DHHS Provider Playbook resources and training opportunities

*All Medicaid Prepaid Health Plan (PHP) contracts signed prior to the delay will remain in effect unless otherwise specified or termed by the individual PHP or Provider.  There is no need to request a new contract at this time if you obtained a fully executed contract prior to the delay

Do you need to make changes to your roster?

Your regional CCHN Provider Engagement Coordinators are also here for you!

Your provider engagement coordinator will be reaching out to schedule your provider orientation. Our goal is to customize this process to what works best for YOU and we would love your input! We invite you to complete this survey so we can gather a few of your preferences. Orientations will be conducted 90 days before go-live.

Updated NC Medicaid Provider Playbook Available

As North Carolina moves closer to implementing Medicaid managed care, the state has published additional information in its NC Medicaid Provider Playbook to help you make the transition. The move to managed care is set to ‘go live’ July 1.

One fast approaching date to keep in mind is February 1, which is the deadline for you to contract with the pre-paid health plans (PHPs) if you want to be included in the open enrollment phase of the transition.

More information on contracting and the timeline are included in these updated parts of the playbook: