BEAUFORT — Carteret County Department of Social Services workers have been preparing for months for the state’s new Medicaid Managed Care system, which takes effect Thursday, July 1.
The N.C. Department of Health and Human Services launched the statewide open enrollment for N.C. Medicaid Managed Care March 15, and County DSS Director Clint Lewis said his department has been busy.
“This is the biggest thing to hit Medicaid,” Mr. Lewis said. “We sent out the enrollment packets March 1 and we’re distributing the information online. We’re getting the information out to medical providers.”
Mr. Lewis added that his agency is bracing for many phone calls about the new system.
“We’ve been getting a lot of calls, especially from the older population,” he said.
Beginning July 1, N.C. Medicaid beneficiaries will receive benefits one of two ways: direct or managed care.
N.C. Medicaid Direct, the current fee-for-services program, involves the state reimbursing physicians and health care providers based on the services they provide to Medicaid beneficiaries.
The new N.C. Medicaid Managed Care involves the state contracting with prepaid health plans, or PHPs, that will assume all the risk for the members they cover. PHPs will be paid a pre-determined set rate per person each month to provide health care services.
Those required to enroll in Medicaid Managed Care must do so by Friday, May 14. If they don’t, they will be automatically enrolled in a plan Saturday, May 15.
In the first 90 days after their effective coverage date, beneficiaries can change health plans for any reason. After that, unless there is a special reason, beneficiaries cannot change plans until the next Medicaid recertification date.
Within Medicaid Managed Care there are two plans: standard plans, where members will receive integrated physical and behavioral health services beginning July 1, and tailored plans, which are specialized plans that offer integrated services for members with significant behavioral health needs and intellectual/developmental disabilities. The tailored plans take effect July 1, 2022.
“We’ll have 7,000 or more beneficiaries in Carteret County enrolled in managed care this year and we’ll have 2,600 in the roll out next year in the tailored plans,” DSS Economic Services Program Manager Sharon Lowery said.
Others will remain on the current Medicaid Direct Plan. There are 13,253 county residents enrolled in some type of Medicaid coverage, according to Ms. Lowery.
Some people will not need to choose a new health plan because of the type of health services they need. N.C. Medicaid determines who must choose a health plan. Those required to choose a plan are most Family and Children’s Medicaid recipients, pregnant women, N.C. Health Choice recipients and non-Medicare aged, blind and disabled individuals.
Those excluded from choosing a health plan are those on the family planning program, the medically needy and refugee Medicaid recipients.
There are some who are temporarily excluded and become mandatory later. This includes dually eligible Medicaid/Medicare recipients, foster care/adoption families and those in community alternatives programs.
The Eastern Band of Cherokee Indians Tribal Option is an additional managed care option available for federally recognized tribal members.
Those enrolling in N.C. Medicaid Managed Care must choose one of four health plans and a primary care provider. Carteret County beneficiaries can choose from WellCare, UnitedHealthcare, HealthyBlue and AmeriHealth Caritas. Ms. Lowery said an enrollment specialist can assist beneficiaries in choosing a health plan and provider.
As for what’s new under the managed care plan, Ms. Lowery said beneficiaries can choose their own health care plan, Medicaid services will be administered by health plans, beneficiaries will contact their plan for nonemergency medical transportation and they will receive their health plan card through the health plan.
Benefits that will stay the same include eligibility rules, health services, treatments and supplies are covered, Medicaid co-pays and beneficiaries will continue to report changes to their local DSS.
Those enrolling in plans can do so online at ncmedicaidplans.gov, through the N.C. Medicaid Managed Care Mobile app available on Google Play or the App Store, by calling an enrollment specialist at 1-833-870-5500 or by returning the enrollment form sent out with enrollment packets.
The N.C. Medicaid Managed Care website offers a variety of tools and information to assist beneficiaries in choosing a primary care provider and a health plan. Tools include frequently asked questions, a chat function, the Medicaid and N.C. Health Choice Provider and Health Plan Lookup Tool with four categories of search capabilities, advanced search based on specialty and the ability to view all providers within an organization/location and by practice name.
For more information, beneficiaries can reference the enrollment packets that were mailed to them, visit the N.C. Medicaid Managed Care website or call the N.C. Medicaid Managed Care Call Center at 833-870-5500.
Contact Cheryl Burke at 252-726-7081, ext. 255; email [email protected]; or follow on Twitter @cherylccnt.