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Medicaid Transformation - Information for Members

The North Carolina General Assembly passed a law that was signed by Governor Cooper to approve funding for Medicaid Transformation. Managed care implementation NC Medicaid will now go live in July, 2021 for the Standard Plans, and July, 2022 for the Tailored Plans.

Nothing will change for Medicaid beneficiaries for now; they will get health services as they do today. Behavioral health services will continue to be provided by Local Management Entities/Managed Care Organizations (such as Trillium). All health providers enrolled in Medicaid are still part of the program and will continue to bill the state through NCTracks. More information can be found at: https://www.ncmedicaidplans.gov/

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The 1115 Waiver seeks to transition Medicaid services in North Carolina from fee-for-service to managed care. Services will be offered through two distinct products: Standard Plans and Behavioral Health (BH) and Intellectual/Developmental Disabilities (I/DD) Tailored Plans. Standard Plans will serve most Medicaid and NC Health Choice members, including all adults and children and those with mild to moderate behavioral health needs. 

BH I/DD Tailored Plans are specifically designed to serve the complex needs of individuals with significant behavioral health disorders, intellectual and developmental disabilities, and traumatic brain injury — populations Trillium and all other LME/MCOs have long served. The Tailored Plans will also serve uninsured individuals currently receiving state-funded services, regardless of their diagnosis.

Both Standard Plans and BH IDD Tailored Plans will integrate physical health, behavioral health, and pharmacy services to best serve individual needs. To learn more, please visit the new NC Medicaid Managed Care website here. Trillium will continue to serve members with complex needs (significant behavioral health disorders, intellectual and developmental disabilities, substance use disorders, and traumatic brain injury) once the Standard Plans go live in 2021. Tailored Plans will not launch until 2022.

Both Standard Plans and BH IDD Tailored Plans will integrate physical health, behavioral health, and pharmacy services to best serve individual needs. To learn more, please visit the new or view the below. Trillium will continue to serve members with complex needs (significant behavioral health disorders, intellectual and developmental disabilities, substance use disorders, traumatic brain injury, and foster children) once the Standard Plans go live. Tailored Plans will not launch until later.

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INFORMATION FOR MEMBERS AND FAMILIES

Members do not need to do anything at this time. They will be contacted by the state if the state determines they will be served by the Standard Plan. Notification letters will include instructions if they feel they should be served by the Tailored Plan.  The state has published a “County Playbook: Medicaid Managed Care” website that will post many of the letters and communications that will be developed for members. 

Members will be encouraged to “raise their hand” and request transition to the Tailored Plan if they have been placed on the Standard Plan. Members who use certain services for their developmental disability, mental illness, traumatic brain injury, or substance use disorder (for example, need access to State-funded or B3 services, are on Innovations Waiver, OR are on the Innovations waiting list) may choose to follow the directions in the letter and ask to be served through the Tailored Plan.

NC Medicaid enrollment broker webpage will have new information starting January 1, 2021. This new information will help members in selecting a health plan offered through the Standard Plan. 

HELP STOP FRAUD & ABUSE

You can help keep fraud, waste, abuse, unethical, or illegal activity out of our workplace. If you are uncomfortable communicating a concern in person, report it anonymously by calling the toll-free hotline number, 1.855.659.7660, or report it online at EthicsPoint and follow the instructions on the screen