Transformation

Medicaid Managed Care transformation efforts have restarted. Standard Plans are scheduled to go live July 1, 2021, while Behavioral Health I/DD Tailored Plans are scheduled to launch July 1, 2022. Until that time, NC Medicaid will continue to operate under the current fee-for-service model administered by the Department. 

• Beneficiaries: Continue accessing health services as you do now. Information on how to enroll in a Medicaid Managed Care health plan will arrive in early spring. Please call the Medicaid Contact Center (888-245-0179) with questions.
• Providers: Continue to contract with health plans.

The Medicaid Transformation website contains policy papers, fact sheets and other transition documents with information effective on the date published. They do not reflect current launch dates. 

Background
In 2015, the NC General Assembly enacted legislation directing DHHS to transition Medicaid and NC Health Choice from fee-for-service to managed care. Under managed care, the state contracts with insurance companies, which are paid a predetermined set rate per enrolled person to provide all services. The Department was on track to go live Feb. 1, 2020; however, new funding and program authority were required from the General Assembly to meet this timeline and Medicaid Managed Care was suspended in November 2019. In July 2020, legislation authorized the restart of Medicaid Managed Care transformation efforts with a July 1, 2021, launch date for Standard Plans and a July 1, 2022, launch date for Behavioral Health I/DD Tailored Plans.