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Medicaid Transformation - Information for Providers

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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 (SP) and Behavioral Health (BH) and Intellectual/Developmental Disabilities (IDD) Tailored Plans (TP). 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 IDD Tailored Plans will be specifically designed to serve the complex needs of individuals with significant behavioral health disorders, intellectual and developmental disabilities, substance use disorders, and traumatic brain injury, as well as foster children — populations Trillium and all other LME/MCOs have long served. We also expect the Tailored Plans will 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. 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 in February 2020. Tailored Plans will not launch until 2021.

 

INFORMATION FOR PROVIDERS

DHHS launched a “Provider Playbook,” an online resource for those who deliver health care services to Medicaid beneficiaries, including independent providers and practices, local health departments, federally qualified health centers and clinics, health care systems, and our many other community partners. In addition, DHHS has researched several issues raised by providers and have included the resolutions or next steps in the Q&A section of the Provider Playbook. New provider tools and information will be added as they become available.

Trillium will work with DHHS to develop a training plan for providers; we will share details and registration information with providers when modules have been scheduled.

Members have been 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. Providers will be instructed on forms to use to help a member transition from a Standard Plan to a Tailored Plan. 

Standard Plans will now launch in one phase:

  • DHHS announced on September 3 that the first phase of Medicaid Transformation will not take place on November 1, 2019, as planned.  Instead, the entire State will transition on February 1, 2020. Read the DHHS Press Release  HERE  

Revised Enrollment and Launch Timeframe Time line medicaid transformation picture 
Timeline copied from the NC DHHS Transition of Care Crossover Overview. 
For more information, please visit here: NC Medicaid Transformation Update

 

 

Quick and easy for members to enroll
Enroll from your smartphone (Android or iPhone).
To get the app, search for NC Medicaid Managed Care on Google Play (Android) or the App Store (iPhone).

 

Google play button App Store button

Members can use the app to find primary care providers and compare health plans.

NC Medicaid Managed Care Regions and Rollout Date - New Date Announced

Timeline map

Click the map to enlarge


Maximus

DHHS has contracted with Maximus, also referred to as the “Enrollment Broker,” to assist members with enrolling in a plan and switching between plans. For more information, please visit their website at NC Medicaid Plans or call 1-833-870-5500 (TTY: 1-833-870-5588). DHHS has also provided information to all MCO call centers to assist members or providers as needed, and also when to provide a warm handoff directly to the Enrollment Broker.