NC Collaborative on Medicaid Transformation
Our purpose
- Connect, educate and support diverse organizations interested in or affected by Medicaid Transformation in North Carolina.
- Elevate the community and consumer voice to improve Medicaid Transformation.
- Support the implementation of Medicaid Transformation.
- Leverage expertise within Medicaid Transformation efforts.
What will you gain by being a part of this statewide effort?
- Accurate, up-to-date information related to Medicaid transformation
- A community of diverse organizations that are committed to improving the health of North Carolinians.
Ready to get involved?
- Click here to subscribe to updates from the NC Collaborative on Medicaid Transformation.
- Attend our meetings. Click here for dates, times and locations.
- Email Jalah Clayton, at jclayton@caresharehealth.org for more information.
Recent Updates
February 23, 2023
NC DHHS has announced that implementation of the NC Medicaid Managed Care Behavioral Health and Intellectual/Developmental Disabilities (I/DD) Tailored Plans will be delayed until October 1, 2023 instead of April 1, 2023.
To ensure beneficiaries can seamlessly receive care on day one, NCDHHS is delaying the implementation of NC Medicaid Managed Care Behavioral Health and Intellectual / Developmental Disabilities Tailored Plans until Oct. 1, 2023.
Tailored Plans, previously scheduled to launch April 1, will provide the same services as Standard Plans and will also provide additional specialized services for individuals with complex behavioral health conditions, Intellectual/Developmental Disabilities (I/DDs), and traumatic brain injury (TBI).
Our highest priority is making sure that the transition to Tailored Plans is as seamless as possible for the beneficiaries they will serve. The individuals who will be served by Tailored Plans often have complex behavioral and physical health needs and, as a result, their care is often more complex too. This increases the importance of a smooth transition with minimal disruption.
The most important aspects of a “smooth transition” are straightforward: On Day 1, people can get the care they need, people can get their prescriptions filled and their providers can get paid. Although the Local Management Entity/Managed Care Organizations (LME/MCOs) made progress toward this goal, and NCDHHS worked hard to ensure readiness, more time is needed to ensure Tailored Plans are where they should be statewide. As a result, the latest data projects that if we launched April 1, 20,000 to 30,000 of the people who will be in Tailored Plans would likely not have their current primary care provider in network.
The delayed start of Tailored Plans allows LME/MCOs to contract with more providers to support member choice and to validate that data systems are working appropriately.
Beneficiaries set to receive care through the Tailored Plans will continue to receive services as they do today:
• Behavioral health services, and I/DD and TBI supports through their LME/MCO
• Physical health and pharmacy services through NC Medicaid Direct.
Tailored Care Management, which launched Dec. 1, 2022, will continue to be implemented. For more information about Tailored Plans please visit NC Medicaid’s Tailored Plan website.
September 29, 2022
NC DHHS has announced that implementation of the NC Medicaid Managed Care Behavioral Health and Intellectual/Developmental Disabilities (I/DD) Tailored Plans will be delayed until April 1, 2023 instead of December 1, 2022.
Tailored Plans, originally scheduled to launch Dec. 1, 2022, will provide the same services as Standard Plans in Medicaid Managed Care and will also provide additional specialized services for individuals with significant behavioral health conditions, Intellectual/Developmental Disabilities and traumatic brain injury.
The delayed start of Tailored Plans allows Local Management Entity/Managed Care Organizations, which will operate the Tailored Plans, more time to contract with additional providers to support member choice and to validate that data systems are working appropriately. The decision is supported by the leadership of the state’s six LME/MCOs.
While the start of Tailored Plans will be delayed, specific new services will still go live Dec. 1, 2022.
NCDHHS and LME/MCOs will support providers of Tailored Care Management to launch their services on Dec. 1. Through Tailored Care Management, eligible beneficiaries will have a single designated care manager supported by a multidisciplinary team to provide integrated care management that addresses the beneficiary’s whole-person health needs.
In addition, pending approval from the Centers for Medicare and Medicaid Services, NCDHHS will implement the 1915(i) option on Dec. 1. This program provides services to help beneficiaries remain in their homes and community-based settings through services such as Respite, Individual and Transitional Supports, Community Living and Supports, Community Transition and Supported Employment.
Beneficiaries set to receive care through the Tailored Plans will continue to receive behavioral health services and I/DD and TBI supports through their LME/MCO and physical health and pharmacy services through NC Medicaid Direct, just as they do today.
More information regarding the beneficiary choice period and other key dates leading up to the April 1, 2023, launch will be shared by NCDHHS in the coming weeks.
For more information visit NC Medicaid’s Tailored Plan website.
August 4, 2022
Since it began in January 2020, the COVID-19 federal Public Health Emergency (PHE) helped prevent NC Medicaid beneficiaries from losing their health coverage during the pandemic, even if someone’s eligibility changed. The PHE also helped health care providers keep their practices running so they could deliver care to Medicaid beneficiaries.
NC Medicaid has launched a new webpage to help provide guidance on preparing for the end of the PHE. The webpage offers information and resources including a communication toolkit for community partners who work closely with beneficiaries as we work together to ensure consistent access to care. You are encouraged to share this information with your partners and stakeholders.
Preparing for the End of the COVID-19 Federal Public Health Emergency Webpage
NC Medicaid End of COVID-19 PHE Toolkit
The federal PHE currently extends beyond Oct. 13, 2022. While we do not know when the PHE will end, NC Medicaid wants to help beneficiaries, providers and community stakeholders understand any potential impacts and steps they can take to be ready.
