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NC Medicaid Transformation Delay

In September 2019, NCDHHS announced that it will extend open enrollment for Medicaid beneficiaries and move to a statewide transition to managed care on February 1, 2020. Medicaid transformation was originally scheduled to roll out in two phases, the first beginning on November 1, 2019. The timeline was adjusted because of a continuing budget stalemate. The updated timeline only impacts counties originally included in phase 1; it does not impact counties that were scheduled for phase 2. Fore more information about the delay, visit NC DHHS.

In February 2019, NC DHHS announced the four entities who have received contracts to participate as Prepaid Health Plans (PHPs) in Medicaid Managed Care:

  1. AmeriHealth Caritas North Carolina, Inc.
  2. Blue Cross and Blue Shield of North Carolina
  3. UnitedHealthcare of North Carolina, Inc.
  4. WellCare of North Carolina, Inc.

A regional contract for Regions 3 and 5 was awarded to Carolina Complete Health, Inc.

The four statewide Standard Plan PHPs and the regional PLE are now beginning to enroll physicians in these Medicaid networks. NCPA encourages psychiatrists to begin contract negotiations with any or all of these Medicaid Managed Care networks. These plans are required to accept "any willing provider" who meets quality standards and accepts the Plan reimbursement rate (remember, these companies are required to pay more than the current Medicaid rate). If you are not a Medicaid provider, consider becoming one! Medicaid Managed Care organizations are required to have network adequacy.


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