This webpage is designed to alert providers to up-to-date information from the State regarding Medicaid Transformation. To assist with a smooth transition, Alliance is encouraging its providers to become familiar with Medicaid Transformation and what it means for our members. This page will be updated with new information as it comes in so it is highly recommended that you check back here and the DHHS Medicaid Transformation website for regular updates.
Alliance will also provide updated information in the Provider News Service. Providers can sign up for and see the most recent newsletter.
NC’s plan for Medicaid Transformation will embody whole person care. This involves providing services and supports for a member’s physical, pharmaceutical, behavioral and social determinant needs. There will be two separate identified plans – Standard Plans and Tailored Plans.
Medicaid Transformation Resumes
NC DHHS shared its plan to resumed implementation of Medicaid managed care when Governor Cooper signed five bills into law. Alliance has been informed by DHHS that the Tailored Plan Request for Application (the procurement process for the Tailored Plan) is scheduled for release in November 2020.
UPDATE: Due to the delay in the launch of NC Medicaid Managed Care, training materials provided here are no longer current.
- Throughout autumn of 2019, LME-MCOs and NC DHHS jointly sponsored provider trainings on NC’s transition to Medicaid Managed Care in anticipation of the program’s February 1, 2020 launch date. Updates to these trainings are forthcoming.
- NC Managed Care for Standard Plans will go live on July 1, 2021.
- NC Managed Care for Tailored Plans will go live on July 1, 2022.
- NC Medicaid will continue to operate under the current fee-for-service model administered by NC DHHS until the above go live dates.
What is a Standard Plan?
Individuals who are considered to be in the mild-to-moderate range regarding mental health/substance use symptoms and need support for those needs. (See below under “Tailored Plan” to see which services will be under the Standard Plans.)
Four statewide and one regional Standard Plans will operate in North Carolina:
AmeriHealth Caritas North Carolina, Inc.
Sheryl Swanson – BH/IDD Provider Network Consultant – (717) 514-5250
Sheron Rankins – Corporate Director Provider Network Management – (704) 437-4101
Katey Weaver – Corporate Population Health (integrated BH/PH management) – (717) 497-9564
Blue Cross and Blue Shield of North Carolina
Health Blue Network Development – (844) 415-2045
Network Development Representatives are available to assist providers Monday through Friday 8:00am-5:00pm ET.
United Healthcare of North Carolina, Inc. (Optum)
Provider Relations Team main contact for NC:
Amy S. Rice – Director of Behavioral Network Services
firstname.lastname@example.org – (813) 877-6829
Additional links on finding online resources, including how to contact the NC Provider Relations Team, can be found at:
Wellcare of North Carolina, Inc.
Jason A. Young MS – Sr. Manager, National Network Management, Behavioral Health
email@example.com – (813) 206-4056
Claudia Phillips – National Network Management Specialist, BH
firstname.lastname@example.org – (312) 833-2748
Carolina Complete Care (Cumberland County only)
Betsey Hamburger – email@example.com – (919) 719-4161
All providers: approved PHP provider contract templates as of May 31, 2019. Visit this website for information on the contracts that have been approved for the Standard Plans.
What is a Tailored Plan?
North Carolina will launch specialized managed care plans, called BH I/DD Tailored Plans, starting in 2021. These plans are designed for those with significant behavioral health (BH) needs and intellectual/developmental disabilities (I/DDs). BH I/DD Tailored Plans will also serve other special populations, including Innovations and traumatic brain injury (TBI) waiver enrollees and waitlist members. Often this is called the “high risk” population.
These tables show the breakdown of services covered by the Standard Plan (SP), Tailored Plan and both:
The Tailored Plan will be operated by Alliance Health within our catchment area. The NC DHHS website is a great source of information regarding the transformation:
Comprehensive paper from NC DHHS detailing current Tailored Plan
Medicaid Transformation Timeline
- November 2020 – DHHS releases Tailored Plan Request for Application (RFA)
- January 2021 – Tailored Plan RFA due
- May 2021 – DHHS awards Tailored Plan contracts
- July 2021 – Standard Plans launch
- January 2022 – Tailored Plan readiness reviews (projected)
- July 2022 – Tailored Plans launch