North Carolina Medicaid Enrollment in Managed Care Information for Providers

After 5+ years of tireless work, the Medicaid Transformation is nearing completion. The new transformation will change the Medicaid plans from fee-for-service to managed care. This change should save the state money on rising health care costs. After a $2 million advertising campaign, only 10% of North Carolina residents selected their new Medicaid insurance plan (as of May 13, 2021). 

Beneficiaries Can Change Their Medicaid Plan 

There are 1.6 million people eligible to select a new Medicaid health care plan in North Carolina. If anyone missed the May 14 deadline, they were automatically enrolled into a health plan. The chosen plan may or may not allow them to keep the same primary physician. 

If anyone is unsure if they are part of 1.6 million people to select a plan, this NC Medicaid Managed Care Fact Sheet will provide additional information. 

Make Changes Until September 30

If Medicaid beneficiaries want to change their plans, they will have until September 30, 2021, to select a different plan or choose a primary care provider (PCP) for any reason. 

After September 30, everyone will be committed to their pre-selected or auto-selected plan until the next Medicaid recertification date. If the beneficiary needs to make a change, they will need to have a special reason. 

Medicaid Transformation Benefits  

Whether beneficiaries already selected their plan or were automatically enrolled in one, they still receive the following Medicaid benefits. 

  • Access to the same Medicaid services currently offered.
  • Access to potential enhanced services not previously provided.
  • Medicaid eligibility rules will remain the same.

There’s Still Time to Make Changes

North Carolina is encouraging everyone to select the best plan for them (even if they missed the open enrollment deadline). Beneficiaries should review the available plans and choose one that fits them best. 

There are three different enrollment options:

  1. Enroll online
  2. Enroll with a phone call to the Medicaid Enrollment Broker Call Center – 833-870-5500 (TTY: 833-870-5588) 
  3. Enroll with the Medicaid Managed Care mobile app – Available for free on Google Play or the App Store 

North Carolina Medicaid Transformation 

The transition process from fee-for-service to managed care took time and many steps to complete. Five insurance companies won contracts that total about $6 billion a year. This transformation hopes to reduce North Carolina’s overall health care costs. 

Reducing Health Care Costs

This transformation is North Carolina’s most expensive program but should save the additional state money on health care costs. The five insurance companies are provided state funds based on the average per person rates (from the awarded contacts). The insurance companies that stay under the expenses will be able to keep any profits. 

Read more about those five companies and contacts here

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