RALEIGH — The North Carolina Department of Health and Human Services today released a detailed proposed design for transforming the state Medicaid and NC Health Choice programs to managed care, as directed by the North Carolina General Assembly in 2015. DHHS is accepting comments on this proposal through Sept. 8, 2017.
“We have put forward a detailed proposed design for a Medicaid managed care system that will deliver an innovative, whole-person-centered, well-coordinated system of care,” said Dr. Mandy Cohen, Secretary of DHHS. “We are grateful for the thoughtful insights provided by hundreds of health care professionals, beneficiaries and other stakeholders, and DHHS welcomes feedback on this proposal.”
Medicaid managed care will be a significant change for the North Carolina Medicaid system. DHHS is releasing its proposed program design to ensure stakeholders have an opportunity to comment on managed care specifics.
“Our proposed Medicaid managed care program design reflects the specific strengths and needs of North Carolina,” said Dave Richard, Deputy Secretary for Medical Assistance.
Richard said the proposed design supports:
Integrating services for physical health, behavioral health, intellectual and developmental disabilities, and substance use disorders;
Addressing unmet social needs and their effect on overall health; and
Building on and strengthening what is working well today, such as care management, while supporting providers and beneficiaries through any changes during the transition and beyond.
The proposal touches on a variety of topics related to the design and implementation of Medicaid managed care in North Carolina. The paper lays out a timeline for transition of key functions and highlights how managed care can meet the needs of complex populations (e.g., people dually eligible for Medicaid and Medicare). It discusses how certain aspects of today’s Medicaid program, like beneficiary appeals and care management, will transition under managed care. Further, the program design describes how providers and plans will contract with each other consistent with protections in North Carolina law, how data will move through the system, and how DHHS will hold plans accountable for meeting standards and delivering high quality care.
The DHHS proposed program design for Medicaid managed care is available on the Medicaid transformation website. Printed copies can be picked up at the Department of Health and Human Services, Dorothea Dix Campus, Adams Building, 101 Blair Drive, Raleigh. A summary of public comments, including those from the recent April and May 2017 statewide public input sessions, are available on the Medicaid transformation website.
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