NC MedicaidNC Medicaid Managed Care Transformation efforts continue. Standard Plans went live on July 1, 2021, while Behavioral Health I/DD Tailored Plans implementation is currently scheduled for July 1, 2024. Background: In 2015, the NC General Assembly directed the transition of Medicaid to a privatized managed care structure. For the first time in NC Medicaid history, we will have an integration of behavioral health and physical health reimbursement dollars. In February 2019, NC DHHS announced the four entities that have received contracts to participate as Prepaid Health Plans (PHPs) in Medicaid Managed Care:
A regional contract for Regions 3 and 5 was awarded to Carolina Complete Health, Inc. Quicklinks to Plan Resources: NC DHHS | AmeriHealth Caritas | Carolina Complete Health | Healthy Blue | United Healthcare | WellCare Psychiatrists can and should enroll with both the Standard Plans and Tailored Plans. Standard PlansThe Standard Plans will cover "mild to moderate" mental illnesses in the Medicaid population, and psychiatrists will be included in the networks to help take care of these patients. These plans are required to accept "any willing provider" who meets quality standards and accepts the Plan reimbursement rate. NC DHHS is requiring that all of the Plans use the NC DHHS credentialing and enrollment system, a single statewide formulary to streamline the process. Back to top Resources:NC DHHSFor more information on Medicaid Transformation developments, visit the NC DHHS website.
AmeriHealth CaritasProvider Support Number: 888-738-0004
Carolina Complete HealthProvider Support Number: 833-552-3876
Healthy BlueProvider Support: 844-594-5072
United HealthcareProvider Support: 800-638-3302
WellCareProvider Support: 866-799-5318
Tailored PlansNorth Carolina will launch Tailored Plans on July 1, 2024, these will be integrated health plans for individuals with behavioral health, I/DD needs, or those on innovations or TBI waivers or waitlists. Approximately 200,000 beneficiaries will be enrolled in Tailored Plans. Tailored Plans will remain regional, and they will be able to close their provider panels as needed. They will cover all the behavioral health services covered by the Standard Plans but will also exclusively cover some enhanced behavioral health services (such as Intensive In-Home, ACT, and Residential SUD treatment). Psychiatrists are encouraged to contract with each Tailored Plan in their service area. Once contracted has been completed, it takes approximately two to three weeks to be added into the Tailored Plan system and show up as an in-network provider. Provider ContractingAllianceChief Medical Director: Robert MacArthur, MD
Partners Health Management Chief Medical Officer: Bess Stanton, MD
Trillium Health Resources Chief Medical Officer: Michael Smith, MD
Vaya Health Chief Medical Officer: Richard Zenn, MD
Resources:Fact Sheet: What Providers Need to Know: Part 1 Recorded NC Medicaid Training Courses |