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Medicaid Expansion Member Resources & Updates 2023-2024

Beginning December 1, 2023, more North Carolinians will be able to get health coverage through NC Medicaid.

NC will expand Medicaid starting December 1, 2023. Adults ages 19-64 earning up to 138% of the federal poverty line (e.g., singles earning about $20,000/year or families of three earning about $34,000/year) may be eligible.

This will be a game changer for the more than 600,000 people who will be able to access health care and is the most significant investment in the health of our state in decades. 





Updated Oct., 9, 2023

NC DHHS has released a new website, bilingual toolkit and a sign-up form to stay updated on the most current information about how more North Carolinians will be able to get health coverage through NC Medicaid. Please use these tools with your networks and communities.

The bilingual toolkit includes:

  • Day 1 Flyer: An overview of who is eligible and how to enroll.
  • Newsletter Template: Content to include in your newsletters and emails.
  • Social Media: Graphics and posts to share on your channels.
  • Family Planning Flyer: Information for the approximately 300,000 people who receive limited benefits through Family Planning Medicaid who will be automatically enrolled in full Medicaid.
  • Medicaid Essentials Deck: A presentation to share with your community on who is eligible and how to enroll.
  • FAQ: Answers to common questions.
  • ePass Video: An overview of how to apply online through ePass.

To stay updated with the latest information, be notified when the application process goes live, and receive the newest resources, complete this sign-up form.

Thank you for helping more people in your communities get health coverage through NC Medicaid. Together we will ensure more than 600,000 people gain access to health care across North Carolina.

Updated Nov. 15, 2023. 

Provider and Member Flexibilities for NC Medicaid Expansion Launch

 Several flexibilities will be available on Dec. 1, 2023, to ease provider burden and ensure Medicaid expansion beneficiaries receive needed care.

 NC Medicaid is committed to ensuring our providers and beneficiaries are supported at the launch of Medicaid expansion on Dec. 1, 2023. A key priority at transition is to ensure Medicaid expansion beneficiaries receive the care they need with no interruption.

The Department has policy flexibilities for expansion members and providers treating those expansion members to ensure beneficiaries receive the care they need, while easing provider administrative burden. Unless otherwise noted, the below flexibilities apply to only expansion members.

Providers can identify expansion members by checking the member’s eligibility in the NCTracks Recipient Eligibility Verification feature in the Category of Eligibility section.

Expansion members, for whom these flexibilities apply, will have eligibility categories MXPNN or MXPGN listed.

The Provider Factsheet on Medicaid Expansion has more information for providers related to Medicaid expansion.

Please see the below flexibilities for expansion beneficiaries and providers for the launch of Medicaid expansion. 

  • Medical Prior Authorizations (PA): For medical PAs, between Dec. 1, 2023 and May 31, 2024, health plans will honor existing NC Medicaid medical PAs. Medical PAs are any PA for physical and behavioral health services. This flexibility applies to both in-network and out-of-network providers who are active enrolled NC Medicaid providers.
  •  Pharmacy PAs: For pharmacy PAs, between Dec. 1, 2023, and May 31, 2024, Standard Plans and NC Medicaid Direct will honor existing pharmacy PAs (from NC Medicaid, as well as other health plans). Previous PAs available as of Dec. 1, 2023, will be honored through May 31, 2024, or for the life of the PA, whichever is longer. Plans may consider previous PAs and current drug therapy when making coverage determinations through May 31, 2024. This flexibility applies to both in-network and out-of-network providers who are active enrolled NC Medicaid providers.
  • Expedited PA Requests/Reviews for Expansion Beneficiaries: Health plans are required to implement strategies to minimize disruption of benefits at launch of expansion, specifically related to PAs. Health plans are required to implement processes to allow providers to submit expedited PAs for expansion beneficiaries so that services are not disrupted at transition. This flexibility applies to both in-network and out-of-network providers who are active enrolled NC Medicaid providers.
  • Out of Network Provider Rates: In addition to out of network requirements found in the Department’s Transition of Care policy, between Dec. 1, 2023, and May 31, 2024, health plans must reimburse Medicaid-eligible nonparticipating/out of network providers equal to those of in network providers. This means that medically necessary services will be reimbursed at 100% of the NC Medicaid fee-for-service rate for both in- and out- of network providers.
  • Starting on June 1, 2024, out-of-network providers with whom the health plans have made a good faith effort to contract with, will be reimbursed at no more than 90% of the Medicaid fee-for-service rate. Note: Out of network providers must be enrolled in NC Medicaid to be reimbursed by the health plans.
  • Out of Network Providers Follow In-Network PA Rules: Between June 1, 2024, and Aug. 31, 2024, health plans will permit uncontracted, out-of-network providers enrolled in NC Medicaid to follow in-network provider PA rules. Starting on Sept. 1, 2024, out-of-network providers must seek authorization for all services.
  • Primary Care Provider (PCP) Changes for All Beneficiaries: Between Dec. 1, 2023, and Aug. 31, 2024, all beneficiaries may change their PCP for any reason.

NC DHHS/NC Medicaid Resources 

  • NC DHHS Medicaid Expansion website
  • Day 1 Flyer: An overview of who is eligible and how to enroll.
  • Newsletter Template: Content to include in your newsletters and emails.
  • Social Media: Graphics and posts to share on your channels.
  • Family Planning Flyer: Information for the approximately 300,000 people who receive limited benefits through Family Planning Medicaid who will be automatically enrolled in full Medicaid.
  • Medicaid Essentials Deck: A presentation to share with your community on who is eligible and how to enroll.
  • FAQ: Answers to common questions.
  •  

Applying for Medicaid  

  • The best way to apply is online through ePASS, the state-run online portal through which people can apply for public benefits, including Medicaid. 
  • HealthCare.gov will be able to determine Medicaid eligibility for the expansion population in the near future.


Helping People Apply for Medicaid

Train Staff as Medicaid Ambassadors and CACs

To prepare for Medicaid expansion, NCCHCA recommends that health centers train staff and/or volunteers to help people apply for Medicaid and health coverage available through the Marketplace. HRSA recommends that health centers offer health insurance outreach and enrollment services, which can connect more health center patients to coverage and increase health center revenue, and help your health center retain your patients amid coverage transitions.

Outlined below are two roles—Medicaid Ambassador and Certified Application Counselor—that will prepare health center staff and volunteers to conduct outreach, education, and provide assistance with applying and enrolling in health coverage:

 

Medicaid Ambassador

Certified Application Counselor (CAC)

Designation by NC Medicaid

Designation by CMS; formal training required to become CAC

Provides outreach and education about Medicaid; refers individuals who need assistance completing Medicaid application to a CAC

Provides application and enrollment assistance for coverage through HealthCare.gov (Marketplace and Medicaid)

Can also provide assistance with ePASS if they received training on ePASS

Should not collect or retain Personally Identifiable Information (PII)

Can retain contact information and PII for later follow up with consumers with their permission, in accordance with CAC rules

Should not retain consumer paperwork, social security numbers, documents, or other information

Should not retain consumer paperwork, social security numbers, documents, or other information

 

Due to the distinct roles of Medicaid Ambassadors and CACs, NCCHCA recommends that health centers have staff and/or volunteers be trained as Medicaid Ambassadors and Certified Application Counselors to provide outreach and education about Medicaid and the Marketplace and to help patients connect to health coverage that best meets their needs and eligibility.

 

How to become a Medicaid Ambassador

 

How to become a Certified Application Counselor (CAC)

  • Your health center needs to be a Certified Application Counselor Designated Organization (CDO) to allow staff and volunteers to become CACs. Learn more about becoming a CDO. Current application window to become a CDO closes on December 15, 2023.
  • Health centers that are CDOs should assign staff and volunteers who will act as CACs a unique CAC ID. Instructions for assigning a CAC ID.
  •  Add CACs to your health center’s CAC Roster. The CAC Roster can be accessed via your health center’s CDO agreement with CMS.
  • After being added to the CAC Roster, CACs can access the CAC training at https://portal.cms.gov/portal/.
    • CACs should select the “Federally Facilitated Marketplace (FFM)/Request for MLMS Training Access” in the Application dropdown list.
    • CACs will be required to complete an identity verification. Quick Reference Guide
    • New CACs are required to complete the first eight modules of the training, which takes approximately 7- 8 hours to complete. After the CAC completes the training, the CAC Roster will automatically populate with the CAC’s training completion date. 
    •  Other resources for the CAC training

 Contact April Morgan for more information or questions, morgana@ncchca.org.

Understanding New Medicaid Eligibility Under Expansion

People who are currently eligible for Medicaid will continue to be eligible.

Now, all people who meet the following eligibility guidelines will be eligible:

Family Planning Beneficiaries

Webpage: Being Autoenrolled in Medicaid from Family Planning

People with incomes up to 196% of the FPL can currently qualify for the NC Medicaid for Family Planning (also called Be Smart). There are many people in the program that will be eligible for expanded Medicaid. On Day 1, NC DHHS will move approximately 300,000 beneficiaries who are enrolled in Be Smart/Medicaid for Family Planning AND whose income is at/below 138% FPL into full coverage Medicaid. After expansion launches, there will be beneficiaries who will remain on Medicaid for Family Planning due to their income being between 139-196% FPL.

NCDHHS started contacting the approximately 260,000 people this applies to the week of November 6. Text messages, phone calls and emails are being sent starting this week to let those eligible know to look out for a letter from their local Department of Social Services. The letter will look like this example, available on the NCDHHS website.

These beneficiaries can select a PHP and PCP before December 1, 2023 by calling the Enrollment Broker. The Enrollment Broker will soon send a notice about ability to select a PHP and PCP. If they do not select a PHP and PCP, they will be auto-assigned to a Medicaid plan​.


 

 


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