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Medicaid Transformation - Information for Providers

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:

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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 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 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, and traumatic brain injury once the Standard Plans go live in 2021. Tailored Plans will not launch until 2022.

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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. Previous trainings can be found on the site. 

Members have been encouraged to “raise their hand” and request transition if they have been placed on the Standard Plan and feel they would be better served by the Tailored 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. 

The 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. Medicaid has paused enrollment until they announce a new launch date. 

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