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On February 4th, the North Carolina Department of Health and Human Services (DHHS) announced Standard Plan awardees for the state’s Medicaid transition.

Statewide Awarded Prepaid Health Plans include:

One Regional Awarded Provider-Led Entity:

NC DHHS also announced regions 2 and 4 will be in phase 1 of rollout which will begin November 1, 2019. The remaining regions will be rolled out February 3, 2020.
NC FQHCs are considered essential providers and are expected to be offered good-faith contracts with all plans.

Last Wednesday, the Centers for Medicare and Medicaid Services (CMS) announced approval of North Carolina’s 1115 Waiver, which requested modifications to the way our state runs its Medicaid program. The approval gives NC the authority to implement a Medicaid managed care program according to the timeline and structure proposed by the NC Department of Health and Human Services (DHHS).

Key Aspects of the NC Medicaid Waiver Program include:

  1. Behavioral Health Integration: Mild to moderate behavioral health services will be available through Standard Plans. Individuals needing more intensive BH services shall elect Tailored plans which launch in year 2 of managed care. There will be a specialized behavioral health home model for beneficiaries with complex needs and seamless coordination with physical health care services.
  2. Opioid Strategy: The program intends to Increase access to inpatient and residential services for individuals struggling with opioid and substance use addiction.
  3. Healthy Opportunities Pilot: The program will include a pilot focused on improving health and reducing health care costs in 2-4 regions of the state that will address some/all of five priority areas impacting health: unstable housing, food insecurity, transportation issues, employment challenges and interpersonal safety.

Aspects of the 1115 Waiver that were NOT approved:

This blog post from CMS Administrator Seema Verma outlines the NC Medicaid 1115 Waiver and its innovations.

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