NC Medicaid’s Bumpy Road to Managed Care: What We Know Right Now

December 2019

Post Author

By Sarah Vidrine 


Two out of three people in North Carolina who rely on Medicaid for their health coverage are children. In fact, half of all babies born in our state receive the care they need thanks to Medicaid. The benefits of Medicaid coverage for children are enormous. From regular screenings to preventive dental care, Medicaid provides a strong foundation for children to grow up healthy and productive as adults. This is perhaps the biggest reason that North Carolina needs to get the transition right, as the state’s Medicaid program moves from fee-for-service to managed care.

Managed Care Roll-Out Delayed Indefinitely 

On November 19ththe NC Department of Health and Human Services (NC DHHS) announced that the Medicaid transformation to a managed care system would be indefinitely suspended. Despite a marathon legislative session that dragged on for months beyond the budget deadline, North Carolina’s legislators never agreed on a final budget that Gov. Cooper was willing to sign. As a result, the funding is not in place for NC DHHS to oversee the transition to managed care.  

The NC General Assembly passed legislation in 2015 requiring NC DHHS to transform Medicaid into a privatized system. The federal government approved the move earlier this year. Once that approval was secured, NC DHHS scheduled a phased roll-out for the new privatized plans. The first phase was to begin on November 15, 2019, which was delayed earlier in the fallThe latest announcement from NC DHHS puts all of Medicaid transformation on hold and does not identify a new target date for implementation. 

State legislators are scheduled to dive back into budget negotiations during a special session in January. It’s unclear whether they will be able to agree on a budget that includes the resources necessary for transformation to move forward. 



What has the delay meant for children and families? 

North Carolina families have already faced challenges due to the bumpy managed care roll-out. Some of the challenges that families have reported to NC Child include difficult time scheduling appointments for children with special health care needs, a lack of information about whether their providers would be in-network, and a plethora of inaccurate or conflicting information from a wide variety of sources. 

Cutting through the confusion has been especially difficult. Some families have shared with NC Child that they are getting conflicting information depending on who they talk to: health care providers, the enrollment broker, or other managed care experts.  

What families need to know 

If you rely on Medicaid or work with families who do, here are some important facts to keep in mind (source: NC DHHS): 

  • There will be no change in coverage for those who already have Medicaid. If someone’s coverage is set to end, they will need to re-enroll the same way they have in the pastThis is true even if they already signed up with a managed care plan. 
  • People can continue to see the primary care providers listed on their Medicaid cards. Providers will continue to submit claims and get reimbursed the way they always have. 
  • People who have already selected a private managed care health plan will need to select again once managed care restarts. We do not know when that will be. 
  • People who get care for behavioral health and/or intellectual and developmental disabilities from an LME-MCO can continue to get those services. 
  • The enrollment broker is still available from 7am-5pm Monday-Saturday to answer questions at 833-970-5500 (TTY: 1-833-870-5588). However the broker will not enroll anyone in a health plan. 

Moving the Medicaid system into managed care is an enormous and expensive task. For some children, losing coverage – even temporarily – could be devastating. This transformation requires attention to the smallest details to ensure that no child experiences a lapse in coverage. When the NC General Assembly returns for the special session on health care in January, we urge them to work closely with NC DHHS to ensure that they allocate enough funding to get this massive project right.  

Help for Families 

Disagree with a decision related to your NC Medicaid care? Get free legal help by contacting one of the following organizations: 

 Sarah Vidrine is NC Child’s Health Policy Specialist 

Support NC Child’s work to ensure health and wellness for all NC’s children. Click here to make a donation today.