Medicaid Expansion Member Resources & Updates 2023-2024

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

•  Visit Medicaid expansion website, select “Stay Informed and Make a Difference”, enter contact info, and choose the option to become a Medicaid Ambassador
•   View ePass demo video
•  Attend Medicaid Essentials Training
•  Ambassador should sign confidentiality agreement with their organization (e.g., health center)
•  Ambassador should sign Attestation form
•  Wait to receive additional information from NC Medicaid

 

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:

• Live in North Carolina
•  Between ages 19-64
•  US citizen or other eligible immigration status 
• Household income up to 138% of the federal poverty level

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​.

NCCHCA staff: medicaidquestions@ncchca.org 

Click here to access free enrollment assistance. 

PCP Assignment Tips 

Get prepared to help beneficiaries with primary care provider assignment.

Background: Medicaid beneficiaries who do not actively select a primary care provider (PCP) during application will be auto assigned to a PCP by their prepaid health plan (PHP). There is an algorithm that all PHPs must follow to determine assignment to a PCP if there is no active selection made by the beneficiary. Prior PCP and beneficiary claims history is the primary factor in that algorithm. However, many people newly covered under expansion will not have any recent claims history with NC Medicaid, so beneficiaries may be more likely to be assigned to a PCP they haven’t seen before. As a reminder, beneficiaries are assigned to a practice or Advanced Medical Home as their PCP, not an individual practitioner. Health centers should still receive claims payments for any Medicaid patient seen at your practice regardless of whether the patient is assigned to your practice. However, accurate PCP assignment promotes continuity of care, and a health center will only receive Advanced Medical Home PMPM capitation payments for Members assigned to the practices.

Your health center can proactively help patients make sure their PCP assignment is accurate. Between Dec. 1, 2023, and Aug. 31, 2024, all beneficiaries may change their PCP for any reason.

Steps to Take:

• Review the recording and slides from the November 17 NCCHCA Task Force, which reviewed background on PCP assignment and how to support patients with changes. 
  • https://ncchca.zoom.us/rec/share/b0tEpgbtPcW8dky97Q1dgK3HMuySiHVM1Upb_rReXQ1vgTnxYeYPPTCL071LhLZI.JoK-7IArvZNKLWnu
  • Passcode: t@uR0i@B
• Prepare patient messages. This PCP assignment tip sheet has information for patients about how to select a PCP. Your health center can tailor content to your needs and information.
• Check your listings on the enrollment broker directory. This PowerPoint shows you how to check your health center’s listings on the Enrollment Broker directory. This is very important, as this is the information patients will see when they go to select a PCP with the enrollment broker or plan.

Outreach and In-reach Tips

Get your outreach and in-reach plans ready.  Health centers can be powerful communicators for communities and patients. You can use outreach to educate community members about coverage options and help available to apply for coverage. You can use in-reach to educate existing patients about coverage options and help available to apply for coverage.  Many of the strategies your health center has used for promoting the Marketplace can be adapted to promote Medicaid coverage.

Messaging about Expansion 

• Review the  market research-tested messaging, which NC DHHS has made available for our private review.  This was also covered on the November 17 Task Force call. Recording available here; Passcode: t@uR0i@B

• Check out fliers and other materials from NC DHHS.
  • 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 260,000 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.
  • After Medicaid expansion launches on December 1, some of the above materials will be updated.
• Health centers can also tailor messages to encourage patients to continue visiting your health center as a medical home after they become insured through Medicaid under expansion. 

In-reach Tips

• Check out the in-reach planning tips and in-reach ideas from NC FQHCs with tips for in-reach to let current patients know about opportunities to enroll in health coverage through Medicaid expansion. These strategies were gathered from health centers based on their work to help people connect to Marketplace coverage, so some of the language refers to the Marketplace.

Examples from other health centers

• Check out this clip from the Raleigh News and Observer, where Verlina Lomick from Kintegra shares her health center’s strategies:
  • Verlina Lomick, Advocacy and Outreach Manager at Kintegra Health, said one of the hardest groups to reach to provide information on Medicaid expansion will be those who are homeless. Reaching people experiencing homelessness may “mean going to encampments, to beauty and barber shops or hanging out at the mall,” Lomick said. Kintegra is also partnering with Latino supermarkets and The Salvation Army.

• Cabarrus Rowan Community Health Center (CRCHC) has increased communication throughout all communication outlets regarding Medicaid expansion. Patients receive communication regarding expansion via social media outlets, TV platforms in health center lobbies, and via text and the patient portal. All CRCHC sites have team members who are readily available to answer questions patients may have about Medicaid expansion.

 

Preparing to Offer Enrollment Assistance Tips

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

• Visit Medicaid expansion website, select “Stay Informed and Make a Difference”, enter contact info, and choose the option to become a Medicaid Ambassador
• View ePass demo video
• Attend Medicaid Essentials Training
  • English option, 12/4, 2:00pm
  • Spanish option, 12/13, 11:00am
• Ambassador should sign confidentiality agreement with their organization (e.g., health center)
• Ambassador should sign Attestation form
• Wait to receive additional information from NC Medicaid

How to become a Certified Application Counselor (CAC)

1. 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.
2. 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.
3. Add CACs to your health center’s CAC Roster. The CAC Roster can be accessed via your health center’s CDO agreement with CMS.
4. After being added to the CAC Roster, CACs can access the CAC training at https://portal.cms.gov/portal/

Best Practice for Providing Medicaid Application Assistance via ePASS

If assisting an individual or household with submitting their application via ePASS:

Please login using the primary applicant’s NCID if they are starting a new application. If this is the first time the primary applicant is using ePASS, please create an Individual NCID Account for the primary applicant. The primary applicant is the individual or head of household who is requesting benefits and for whom you are assisting with applying. Click here to create an individual NCID.

Health centers should indicate that they are “assisting someone with applying.”

NCCHCA has consulted with the Charlotte Center for Legal Advocacy (CCLA) about the representative designation and recommends that health centers do not act as an applicant’s representative/designated authorized representative. Per CCLA, a representative/designated authorized representative has authority to make decisions related to a beneficiary's benefits and is allowed to view and request any information in the beneficiary’s case file. Additionally, DSS is required to copy the representative/designated authorized representative on all correspondence to an applicant/beneficiary. Further, applicants and beneficiaries must provide written or verbal consent for the representation to be effectuated, and the same process is required to revoke the authorized representation status. Due to the liability of acting as a representative/designated authorized representative, NCCHCA and CCLA do not recommend that health centers or their staff/volunteers act as a representative/designated authorized representative for Medicaid applicants or beneficiaries. 

Who Will be Eligible? Tips 

Identify your patients who may be affected by Medicaid expansion.

How do you do this?

1.Understand the new Medicaid eligibility rules.

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

Starting December 1, all people who meet the following eligibility guidelines will be eligible:

• Live in North Carolina
• Between ages 19-64
• US citizen or other eligible immigration status 
• Household income up to 138% of the federal poverty level

2. Understand how people with and without current insurance may be affected.

There are many patients who may meet the above qualifications and now qualify for Medicaid. One way health centers can understand more about the needs of specific groups of patients is to understand how people with different insurance statuses may be affected.  The groups below are not mutually exclusive.

• Family Planning Beneficiaries. People with incomes up to 195% 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. Not everyone on Family Planning will transition, only those whose income is at/below 138% of FPL according to the Medicaid records. After expansion launches, there will be beneficiaries who will remain on Medicaid for Family Planning due to their income being between 139-195% FPL. An estimated 300,000 will transition from family planning to comprehensive Medicaid coverage.
• Medicaid Unwinding.  There are many people who have recently lost Medicaid coverage due to the continuous coverage unwinding. Many of these people will again qualify for Medicaid under expansion. Based on trends and estimates from the NC Medicaid unwinding dashboard, as many as 200,000 people who have lost/are expected to lose Medicaid before expansion launches on December 1 may become eligible for Medicaid again under expansion.
• Transitioning from the Marketplace to Medicaid. People with household income between 100-138% of the Federal Poverty Level may be enrolled in a Marketplace plan with premium tax credits. As many as 154,000 people will now be eligible for expanded Medicaid.  These individuals will likely receive a letter at some point from the Marketplace letting them know that they may now be eligible for Medicaid.
• Individuals in the Coverage Gap. Many people who did not qualify for Medicaid prior to expansion but did not make enough money to qualify for financial assistance for a Marketplace plan, have been underinsured or uninsured. An estimated 173,000 will now be eligible for Medicaid.

3.Apply this to your information about current patients.

Health centers can look at information they have about their current patients to try to identify those who may qualify for Medicaid.

• Patients by Income Status: Depending on how your health center keeps records of patient income, you can identify people who are likely to be eligible based on income. Not all of these patients will be eligible due to other qualifications (such as immigration status), but gathering information by income is a great place to start. 
• Health centers can also identify patients who have Medicaid for Family Planning. Many of these people will transition to comprehensive coverage on Day 1. Though they will get information from NC DHHS about this transition, they will likely need help understanding if the transition affects them and how.  
• Patients previously assisted by outreach and enrollment. Many of the people your health center staff may have assisted with health insurance enrollment may need to navigate a transition of coverage. Health center O&E teams can identify those they have assisted in the past who may need messages about Medicaid expansion.

North Carolina Justice Center

• Outreach Resources 
• FAQs about Medicaid Expansion
• NC Health Insurance Eligibility for Immigrants (English) (Spanish)

North Carolina Health Care Association 

• Map: Estimated Impact of Medicaid Expansion in NC 

Week of 1.1.2024 

Starting the first week of January, NCCHCA will be sharing a weekly Medicaid expansion email with health centers. This will include important updates and reminders and may include new learnings from the previous week.   

If you have a tip or promising practice related to expansion to share with other health centers, please email Medicaidquestions@ncchca.org so we can feature it in future updates.  

This email is being sent to health center CEOs, as well as identified Medicaid expansion contacts. If you’d like to add a member of your health center team to the recipient list, email Medicaidquestions@ncchca.org.  

PCP Assignment Issues- Report to Provider Ombudsman  

Issues with PCP assignment?  

If you are seeing significant PCP misassignments, please share those with the provider ombudsman directly with specific examples. Examples of issues that may be shared are beneficiaries being assigned to non-PCP sites (e.g., pharmacies) and beneficiaries being assigned to inappropriate providers (e.g., adult assigned to a pediatrician or beneficiary assigned to a practice not accepting more Medicaid assignments).  

Contact the provider ombudsman by emailing Medicaid.ProviderOmbudsman@dhhs.nc.gov  or calling 866-304-7062 .  

NCCHCA is sharing PCP assignment issues with NC Medicaid and continuing to advocate for sustainable improvements to the process, but it is important that the provider ombudsman also hears directly from providers about specific issues.  

Upcoming Trainings to Support Medicaid Enrollment- Register by January 17  

Care Share Health Alliance, NCCHCA, and the NC Navigator Consortium are collaborating to host Medicaid Expansion Regional Trainings. The Regional Trainings are a two-part series that will cover Medicaid 101 content (Part 1), as well as Medicaid Expansion Outreach, Education, & Enrollment content (Part 2). The purpose of the trainings is to equip health centers and other community partners with the information needed to support communities during the Medicaid Expansion process. 

Medicaid 101 (Part 1) 

Medicaid 101 content will be offered twice. You may attend either the in-person training in Raleigh (1/31) or the virtual training (2/7). Register here. 

Topics covered will include: 

• Medicaid 101 & Managed Care Structure 
• Immigrant Eligibility for Medicaid 
• How to Apply & Next Steps After Applying 
• NC Medicaid Ombudsman 
• Dental Coverage for Medicaid Beneficiaries 
•  Apply & Next Steps After Applying
• NC Medicaid Ombudsman 
• Dental Coverage for Medicaid Beneficiaries 
• In-person at the McKimmon Center in Raleigh on January 31 (Capacity is Limited) 
• Virtually via Zoom on February 7th, 2024
• Part 1 Registration: Medicaid 101 Content

Part 2 Registration: Medicaid Expansion Content  

• Part 2 Training is offered in-person in each of the 6 Medicaid Managed Care Regions
  • February 1st in Raleigh, NC (confirmed venue: McKimmon Center)- Region 4 
  • February 8th in Mooresville, NC- Region 3 
  • February 13th in Greenville, NC- Region 6 
  • February 21st in Winston-Salem, NC- Region 2 
  • February 27th in Fayetteville, NC (confirmed venue: Crown Complex)- Region 6 
  • March 5th in Waynesville, NC- Region 1  

**Please fill out both forms to ensure that you receive both parts of this training.** 

Space is limited, so register ASAP. The registration deadline is January 17th, but slots may fill up before that date.   

If you would be interested in sharing about your organization's work around outreach, education, or enrollment for Medicaid Expansion, fill out this form! We will be highlighting the work of multiple organizations in each region. 

 
Dashboard- Understand how many people have enrolled in your area  

NC Medicaid has launched a new dashboard tracking how many people are enrolled in NC Medicaid as a result of Medicaid expansion. The dashboard is updated monthly.  

Get Free Materials- Order by January 8  

Order Free Printed Materials on Medicaid Expansion by January 8: NC Medicaid is providing free, printed educational materials for partners. Sign up today to receive the NC Medicaid Toolkit materials and swag items available in English and Spanish. Materials will begin shipping in January. To order your materials, please fill out this order form by January 8, 2024.  

NCDHHS Livestream Fireside Chat and Tele-Town Hall: North Carolina Medicaid for More People 

The North Carolina Department of Health and Human Services will host a live fireside chat and tele-town hall Wednesday, Jan. 10, from 6 to 7 p.m., to discuss Medicaid expansion, including impacts on rural communities, who is newly eligible and ways to apply for health care coverage. Learn more here.  

 

Quality Measure Methodology  

Many providers have expressed concerns about the inclusion of the Medicaid Expansion population in quality measurement and incentive programs, as many new members may have been out of care and need additional support. To alleviate providers’ concerns, DHB intends to issue a policy update that creates a fair quality measurement methodology that does not introduce a disincentive for practices to serve Expansion members and encourages engagement of new Expansion members to close care gaps. NCCHCA will share more information as it becomes available.  

Reminder for the Expansion Population: Requirements for Filling Prescriptions for Medicaid Beneficiaries  

NC Medicaid reminds providers that prescriptions written by non-Medicaid enrolled providers will not be reimbursable by NC Medicaid due to federal requirements. NC Medicaid requires that all providers whose NPI will be used on a pharmacy claim be enrolled with NC Medicaid. There are no exceptions to this requirement. This bulletin applies to NC Medicaid Direct and NC Medicaid Managed Care. 

NC Medicaid recommends the following: 

1. Actions for Prescribers: Non-Medicaid enrolled providers treating a beneficiary enrolling in NC Medicaid through Medicaid expansion should consider applying to enroll in NC Medicaid. No additional action is needed for actively participating providers. 
   • To receive payment for office visits for Medicaid beneficiaries, a provider must fully enroll in NC Medicaid. 
   • If the only intent is to ensure prescriptions are paid by Medicaid, non-enrolled providers may choose the lite enrollment option which only allows claim payment when the provider is ordering or referring for services or prescribing medications. The lite provider enrollment process is a simpler and quicker way to enroll into NC Medicaid when the provider does not intend to bill for rendered services. 
2.  Actions for Pharmacies: When pharmacies process prescriptions for NC Medicaid beneficiaries and they are denied due to the provider not being enrolled, they should:  
   • Contact the non-Medicaid enrolled provider regarding enrollment and to inquire if there is another NC Medicaid provider with an established relationship with the beneficiary who can write a new prescription for the beneficiary.  
   • Encourage beneficiaries to schedule an appointment with their new NC Medicaid enrolled provider as soon as possible.
   • Encourage beneficiaries to seek out urgent care or the emergency department if they have an immediate need for medications or a medical emergency. 
   • Encourage beneficiaries to go back to the free clinic (if applicable) to refill their prescription until they can set-up an appointment with their NC Medicaid provider.  

NC Medicaid has developed a flyer which can be posted at pharmacies which links to a next steps document to help beneficiaries resolve this issue.  

Question of the Week  

NCCHCA will share some of the frequently asked questions by NC health center staff each week.  

When can a beneficiary change PCP assignment? 

Between Dec. 1, 2023 and Aug. 31, 2024, all beneficiaries may change their PCP for any reason. This is a special flexibility offered by NC Medicaid due to Medicaid expansion.  

After August 31, 2024, the regular guidelines will apply. Beneficiaries will be able to change their PCP/Advanced Medical Home (AMH) without cause twice each year.  Beneficiaries have thirty (30) days from receipt of notification of their PCP/AMH assignment to change their PCP/AMH without cause (1st instance) and can change their PCP/AMH without cause up to one time per year thereafter (2nd instance).   

Beneficiaries can change their PCP or health plan at any time over the course of the year if they have care or quality concerns. This is known as a change ‘with cause.’ 

Week of 1.8.24

Welcome, new NCCHCA Regional Support Specialists

NCCHCA welcomed the first six of eight Regional Support Specialists that will be supporting health centers with Medicaid outreach and enrollment efforts. In the coming weeks, NCCHCA will be in touch with all CHCs to discuss how they will support your CHC.

 

311,000 people enrolled in Medicaid Health Coverage due to expansion

Per NC DHHS, initial data shows that Medicaid applications in December 2023 were almost double the amount from December 2022. Counties are reporting most applications are coming from ePASS and HealthCare.gov.

 

Medicaid Determinations on HealthCare.gov.

NC Medicaid is hopeful that beginning on February 1, 2024, individuals who apply on HealthCare.gov can be determined eligible for Medicaid by HealthCare.gov. NC Medicaid is working with CMS to make the necessary changes for the determination functionality on Healthcare.gov. This means that people who apply via HealthCare.gov will get faster determinations. Currently, HealthCare.gov can only identify applicants potentially eligible for Medicaid and send their application to NC DSS for a full determination, which can take up to 45 days. ePASS will still be able to process Medicaid applications. If your team will be helping with applications on HealthCare.gov, they need to be trained as a Certified Application Counselor through CMS. NCCHCA will keep you updated as we learn more about the official launch date.

 

Deadline Extended to January 17 for CMS Certified Application Counselor Designated Organization

CMS has extended the deadline for organizations that want to become a Certified Application Counselor Designated Organization (CDO) until January 17, 2024. Having CDO status allows organizations to train staff and volunteers as Certified Application Counselors (CACs) who are certified to assist consumers with applying for coverage available through the Marketplace (HealthCare.gov). NCCHCA encourages all CHCs to become CAC organizations.

To apply to become a CDO, access and complete the CDO application at this link. CMS will review your application and send a determination email with your application status within 10 days. More information and resources about becoming a CDO are available here. 

Letters to Marketplace Enrollees

CMS will begin sending letters on 2/1/2024 to individuals with Marketplace plans with income between 100 and 150% FPL notifying them that they may qualify for Medicaid due to expansion. NC Medicaid has developed a flyer explaining how those currently enrolled in HealthCare.gov marketplace plans may be able to get Medicaid.

Thursday, January 18 | 5:30 p.m.: Medicaid Managed Care Fireside Chat: Key Medicaid Updates

Join NC AHEC for the first Fireside Chat of the new year on Thursday, January 18 from 5:30 to 6:30 p.m. We will bring “the state of the state” that will include sensitive updates for all providers in NC about Medicaid Expansion, Medicaid Quality reports, Advanced Medical Home Modernization, and Tailored Plan Consolidation and Launch. This will also be Dr. Dowler’s final Fireside Chat and we will highlight ‘Medicaid Superlatives’ from her last five years. Register here.

Thursday, January 25 | 2:00pm Medicaid Expansion: Roadblocks & Workarounds Webinar

During this webinar, attendees will discuss common issues they are encountering in the early days of Medicaid expansion and offer solutions or workarounds to those issues. Emma Sandoe, Deputy Director, Medicaid Policy, NC Division of Health Benefits, will be joining the call to answer questions. Register

Week of 1.15.24

Enrollment Continues to Grow

As of January 18, 318,977 people are enrolled in Medicaid health coverage due to expansion.

NC DHHS Media Campaign Launches

NC DHHS paid media campaign launched on January 15. Keep an eye and ear out for digital and radio ads.

Upcoming Training Opportunities

Please be reminded of the below training opportunities, including an important deadline for registration today!

 

• Medicaid Expansion: Roadblocks & Workarounds Webinar- Thursday, January 25 | 2:00pm

During this webinar, attendees will discuss common issues they are encountering in the early days of Medicaid expansion and offer solutions or workarounds to those issues. Emma Sandoe, Deputy Director, Medicaid Policy, NC Division of Health Benefits, will be joining the call to answer questions. Register 

• Medicaid 101 Training and Regional Medicaid Expansion Trainings – Various Dates

Care Share Health Alliance, NCCHCA, and the NC Navigator Consortium are collaborating to host Medicaid Expansion Regional Trainings. The Regional Trainings are a two-part series that will cover Medicaid 101 content (Part 1), as well as Medicaid Expansion Outreach, Education, & Enrollment content (Part 2). The purpose of these training courses is to equip health centers and other community partners with the information needed to support communities during the Medicaid Expansion process. 

You must register for the Raleigh events (Medicaid 101 in-person on January 31 and Medicaid expansion meeting in-person in Raleigh on February 1) by the end of the day, today, Friday, January 19.

Medicaid 101 (Part 1)

Medicaid 101 content will be offered twice.

You may attend either the in-person training in Raleigh on January 31 or the virtual training on February 7.

Register here for Part 1.  Register by end of day Friday, 1/19 for the in-person Raleigh training.

 Topics covered will include: 

• Medicaid 101 & Managed Care Structure 
• Immigrant Eligibility for Medicaid 
• How to Apply & Next Steps After Applying 
• NC Medicaid Ombudsman 
• Dental Coverage for Medicaid Beneficiaries 

Medicaid Expansion Outreach, Education, & Enrollment content (Part 2) 
Part 2 will be offered 6 times, in-person, in locations across the state (dates and locations below). The session topics will be the same at each training. However, presenters will vary based on the region. Register here for Part 2.

Dates & Locations: 

• February 1: Raleigh Register by end of day Friday, 1/19 for the in-person Raleigh training.
• February 8: Mooresville 
• February 13: Greenville 
• February 21: Winston-Salem 
• February 27: Fayetteville 
• March 5: Waynesville 

Topics covered will include: 

• Progress & Roadblocks since Expansion Launch 
• Medicaid Expansion Workflows 
• Messaging Guidelines for Medicaid Expansion 
• Outreach Considerations for Special Populations 
• Application & Enrollment Considerations for Special Populations 
• Overview of Medicaid Expansion Tools 

Week of 2.5.24

PCP Assignment Issues- Report to Provider Ombudsman

Issues with PCP assignment?

If you are seeing significant PCP misassignments, please share those with the provider ombudsman directly with specific examples. Examples of issues that may be shared are beneficiaries being assigned to non-PCP sites (e.g., pharmacies) and beneficiaries being assigned to inappropriate providers (e.g., adult assigned to a pediatrician or beneficiary assigned to a practice not accepting more Medicaid assignments).

Contact the provider ombudsman by emailing Medicaid.ProviderOmbudsman@dhhs.nc.gov or calling 866-304-7062 .

NCCHCA is sharing PCP assignment issues with NC Medicaid and continuing to advocate for sustainable improvements to the process, but it is important that the provider ombudsman also hears directly from providers about specific issues.

NC Medicaid began accepting Federal Marketplace Eligibility Determinations on February 1

NC Medicaid began accepting Federally-facilitated Marketplace Eligibility Determinations (FFM-D) Feb. 1, 2024. This change allows the FFM to make the eligibility determination for individuals who apply for coverage through the Federal Marketplace at HealthCare.gov and whose eligibility is determined following modified adjusted gross income (MAGI) rules.

This change means NC residents who apply for Medicaid through the Federal Marketplace (HealthCare.gov) and are determined fully eligible for Medicaid by the FFM will no longer require an eligibility determination by the local Department of Social Services (DSS) caseworker. Once NC Medicaid receives notification of eligibility, NC FAST will review the case to determine which full MAGI benefit program the individual qualifies for and will send the appropriate final notice of eligibility to the individual.

CMS Mailing Letters Alerting People who may be eligible for expanded Medicaid

CMS is mailing letters to 534,840 North Carolinians based on information provided to HealthCare.gov that indicates they may be eligible for NC Medicaid. The letters will arrive in mailboxes on or after Feb. 1, 2024, and will direct individuals to contact HealthCare.gov to update their information currently available in their HealthCare.gov case file. Sample letters are available on the Medicaid website. Health center staff should be prepared to answer questions from people receiving these letters and should encourage them to update their HealthCare.gov information. 

New Resource: FAQs on immigration status and NC Medicaid eligibility

NC DHHS has added FAQs to their toolkit of resources that focuses on essential information for people who have immigrated to North Carolina and those who work with these communities. This information helps provide guidance around:

• Medicaid eligibility for varying immigration statuses 
• Emergency Medicaid coverage for those who do not qualify for full coverage
• Medicaid for children when a parent is undocumented 
• How applying for or receiving Medicaid does not make someone a “public charge”
• How to find support when applying for Medicaid 

You can view these new FAQs by visiting Medicaid.nc.gov/Immigration.

Medicaid Expansion Outreach, Education, & Enrollment Regional Trainings  
NCCHCA, Care Share Health Alliance, and the NC Navigator Consortium are partnering to host trainings to build capacity to help people apply and enroll through Medicaid Expansion. In-person trainings will be held in each Medicaid region.

Three regions remain!  You can attend any training and do not have to attend the one in your region.

Register here for Part 2.

Dates & Locations: 

• February 21: Winston-Salem; In-person
• February 27: Fayetteville; In-person
• March 5: Waynesville; In-person

Topics covered will include: 

• Progress & Roadblocks since Expansion Launch 
• Medicaid Expansion Workflows 
• Messaging Guidelines for Medicaid Expansion 
• Outreach Considerations for Special Populations 
• Application & Enrollment Considerations for Special Populations 
• Overview of Medicaid Expansion Tools 

Updated Care Management Assumptions for Expansion Population

NC DHHS has released updated information about the assumptions underlying the care management component of capitation payments to NC Medicaid Managed Care Standard Plans, including consideration for Medicaid expansion, effective Dec. 1, 2023.

For the Medicaid Expansion population, on average, $13.65 per member per month (PMPM) is the assumed cost of delivering care management in accordance with NCDHHS’s requirements, compared to $10.17 for non-expansion populations for State Fiscal Year 2024 (July 1, 2023-June 30, 2024). NCDHHS has not established minimum care management fees and maintains the expectation that Standard Plans and practices will arrive at mutually agreeable rates that are commensurate with the intensity and breadth of the care management being provided. More details.

Week of 2.12.24

Enrollment Update from NC DHHS

From NC DHHS: As of Feb. 1, more than half of the anticipated 600,000 people who are newly eligible for Medicaid coverage now have access to comprehensive health care. The Medicaid Expansion Enrollment Dashboard shows that 346,408 people are now enrolled in expanded Medicaid.
Medicaid covered more than 265,000 prescriptions for new enrollees for things like heart health, diabetes, seizures and other illnesses and covered more than $4.8 million in claims for dental services since Dec. 1, 2023.

Complete NC Medicaid Primary Care Provider Panel Management Satisfaction Survey

NC Medicaid is working to improve primary care provider panel management​. Please complete this new, brief seven (7) question survey to get feedback to help guide these efforts.​

• Survey available here: https://gcv.microsoft.us/AKmOWdRplY ​
  • Open for responses until March 26, 2024​
• Questions include:​
  • Current level of satisfaction with the accuracy of your panel of Medicaid patients​
  • How the current accuracy of your Medicaid patient panel compares to the accuracy from three months ago​
  • Issues experienced with the current accuracy (if applicable)​
  • Additional feedback for panel management improvement​
• DHB will be sharing this survey twice more in 2024 (in Summer and in Fall) to understand changes in satisfaction over time as DHB continues to work on improvements.

Let’s make sure CHC voices are represented in this survey!

Welcome, New Medicaid Expansion Regional Support Specialist!

NCCHCA continues to welcome new team members who will be working to support health centers as Medicaid Expansion Regional Support Specialists. This week, we welcomed Hannah Williamson. Hannah will be serving the southeast and supporting CommWell Health, MedNorth, Stedman-Wade, Black River Health Services, and First Choice Community Health Center. NCCHCA will soon have a full staff of 8 regional support specialists, with the final team member expected to join soon. If you have questions about how to get in touch with your health center’s assigned RSS, contact April Morgan at morgana@ncchca.org.

Medicaid Expansion Outreach, Education, & Enrollment Regional Trainings  
NCCHCA, Care Share Health Alliance, and the NC Navigator Consortium are partnering to host trainings to build capacity to help people apply and enroll through Medicaid Expansion. In-person trainings will be held in each Medicaid region.

Two regions remain!  You can attend any training and do not have to attend the one in your region.

Register here for Part 2.

Dates & Locations: 

• February 27: Fayetteville; In-person
• March 5: Waynesville; In-person

Topics covered will include: 

• Progress & Roadblocks since Expansion Launch 
• Medicaid Expansion Workflows 
• Messaging Guidelines for Medicaid Expansion 
• Outreach Considerations for Special Populations 
• Application & Enrollment Considerations for Special Populations 
• Overview of Medicaid Expansion Tools