North Carolina starts Medicaid managed care
(The Center Square) – Nearly 1.6 million North Carolinians started receiving Medicaid services Thursday through managed care health plans.
With the managed care system, the state will base monthly payments per patient on health plan group rates. Medicaid providers enroll with one or more health plan network.
The North Carolina Department of Health and Human Services (NCDHHS) said the payment structure rewards better health outcomes, reducing long-term costs.
“From the start of this process, our goal has been to improve the health of North Carolinians through an innovative, whole-person centered, and well-coordinated system of care,” NCDHHS Secretary Mandy Cohen said. “Today moves us closer to that goal as we begin to implement this important program.”
The state started the transition to managed care after lawmakers passed the plan in 2015. More than 2.5 million people are enrolled in the taxpayer-funded program. More Medicaid recipients will be transferred to managed care in June 2022.
North Carolina spent $16.9 billion on Medicaid in fiscal year 2020 with 2.1 million enrollees. The federal government provided more than $11 billion, $3.8 billion came from the state’s general fund and $2 billion came from other revenue. Medicaid costs expect to be more than $18 billion in fiscal year 2021. There will be a projected $216 million in North Carolina’s Medicaid Transformation Reserve in fiscal year 2021 and $246 million in fiscal year 2022.
“As our role shifts to provide regulatory oversight, we expect on Day One that people get the care they need and providers get paid,” Deputy Secretary of NC Medicaid Dave Richard said. “We also anticipate that health plans will quickly address any bumps in the road as we work together to implement the largest change in NC Medicaid’s history.”
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