Big update: Medicaid Managed Care is rolling out this fall!

August 2019

Post Author

By Ciara Zachary

Seven of every ten people enrolled in Medicaid and NC Health Choice in North Carolina are children. So it’s critical that child advocates pay close attention to changes happening to our Medicaid program right now. North Carolina is in the midst of a complex process to move its Medicaid and NC Health Choice programs from mostly fee-for-service to mostly managed care. 

How will this process impact our state’s children? To answer that question, we reached out to parents across the state, and in March we put together a Parent Advisory Council. Last week, eight parents of children who depend on Medicaid for health care met with NC DHHS leadership to share their perspectives, concerns, and recommendations for Medicaid transformation. 

At the top of PAC members’ list is getting accurate, timely information to Medicaid beneficiaries in simple, straightforward language – and in more than one language. Transportation is also a major concern. While Medicaid often covers transportation to health services, the type and quality of transportation varies widely by county. Many families experience delays, miss significant amounts of work and school, and even miss appointments due to problems with Medicaid transportation services. We’ll share more from our PAC members in a future update. 

Here are three updates on where we are now in the Medicaid transformation process:

  1. Medicaid and NC Health Choice beneficiaries living in regions 2 and 4 began receiving letters about the changes in Medicaid and NC Health Choice at the end of June.

  2. In February 2019, the NC Department of Health and Human Services (NC DHHS) announced the four statewide and one regional prepaid health plans that will receive contracts. Plans that were not awarded contracts contested the Department’s award decision. Those appeals were dismissed by a judge in July, dispelling fears of a delay in rollout.
  3. NC DHHS released a second RFP for an Ombudsman program. The Ombudsman will serve a resource for Medicaid and NC Health Choice beneficiaries as well as help monitor and trends or systemic issues that impact whether Medicaid and NC Health Choice meets its goal for a healthier NC.

As we prepare for Phase I of Medicaid Managed Care to roll out this Fall, NC Child has identified the following priorities – based in large part on input from our Parent Advisory Council members:

Beneficiary Engagement

Shifting to managed care means that parents, caregivers, and families will have to navigate a brand new system. Parents need to make sure that their children will still receive quality primary and specialist care for healthy growth and development. Prepaid Health Plans are required to establish committees to hear from members, but there is no mention of how NC DHHS plans to engage beneficiaries – especially parents and caregivers – to understand whether and how transformation is meeting their children’s needs. Considering that there will not be an Ombudsman in place for Phase I and possibly Phase II, there is even more need for a process for consumers to have their concerns addressed. We launched the Parent Advisory Council (PAC) in part to address this problem. 


Medicaid and NC Health Choice beneficiaries in regions 2 and 4 started receiving enrollment letters from NC DHHS at the end of June. Beneficiaries will have to either select a Prepaid Health Plan, or they will be auto-enrolled in a plan by September 2019. Considering that this is completely new process, NC Child expects that families will have many questions about what Medicaid Managed Care means, and how to choose the best plan for their families. We are encouraged that NC DHHS has an enrollment broker that beneficiaries can contact for assistance.

NC Child recently partnered with the Charlotte Center for Legal Advocacy, Disability Rights NC, National Health Law Program, and the NC Justice Center to create Medicaid Transformation One-Pagers in English and Spanish to raise awareness about the enrollment process and changes coming to the state. You can download those here.

Children’s Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Medicaid benefit

EPSDT is a landmark federally-mandated benefit that guarantees that children get the right care at the right time for all medically necessary services. As the state approaches roll-out in regions 2 and 4 this fall, and the rest of the state in early 2020, NC Child will track how plans prioritize children’s access to the services required by the EPSDT benefit. Further, we want to make sure parents and caregivers understand EPSDT, and how important it is to children’s growth and development.

Over 2 million North Carolinians receive primary and specialty care through Medicaid and NC Health Choice, the great majority of them children. Managing this transformation process well now can set our children up for better health going forward.

Ciara Zachary is NC Child’s Health Program Director

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