Medicaid Reform: Updates

Medicaid Reform: Resources

  • Medicaid-Reform Resources, from the North Carolina Department of Social Services (NC DHHS) NC Medicaid Division of Health Benefits (NC DHB).

Medicaid Reform: Updates

As our Practice Support Team learns of new information on the rollout of managed care that could directly impact your own practice, and your patients, it will be posted here, just as soon as we have verified it.

The latest updates will always appear first, along with the date of posting.

Do not hesitate to contact Marla Smith, Practice Support Program Manager and QI Specialist, with any questions on any of this information, or with any other practice needs related to the rollout of Managed Care. Reach Marla at (252) 902-9221, or

The Latest …

  • 8.7.20
    What happens next with Medicaid transformation?
    Medicaid Managed Care is back on track, and a launch date has been set (by July 1, 2021).In the coming weeks, the Prepaid Health Plans selected to do business in North Carolina (BCBS, AmeriHealth, United, WellCare and Carolina Complete) will start contacting practices to resume the contracting process and complete payer contracts. Other care-management entities/clinically integrated networks (CINs) may likewise reach out to practices about partnering for Medicaid Managed Care.

    Below are two suggestions for medical practices in navigating the weeks ahead:

    • Practices receiving requests from any of the Prepaid Health Plans are invited to contact Access East – we are an accredited care-management entity vetted and approved as an Advanced Medical Home (AMH) Tier 3 care-management partner – for help in completing the requests, and for guidance on receiving favorable AMH payments.
    • Practices that are contacted by other CIN or care-management entities, and that have already decided to partner with Access East, need only inform the contacting entity of this decision.


  • 3.20.20
    Update on State resource support during COVID-19 crisis
    State agencies assume North Carolina now has community spread of COVID-19, with the state increasing its efforts to protect and maintain key resources like healthcare workers. North Carolina Emergency Management proposes addressing potential medical supply shortages in this way, beginning next week:

    • Practices that run out of supplies such as gowns, gloves, swabs, etc., should first call their county’s emergency-management (EM) team; EM contact information, by county:
    • If the county EM team cannot source the need locally, the request will go to the state EM office, which will work with eight (8) regional healthcare coalitions to try to source the supply.
    • The state plans soon to launch a SharePoint for posting issues with the supply chain, or other logistical issues in addressing COVID-19.


  • 3.19.20
    DHHS COVID-19 weekly webinar
    Beginning today at 5:30 p.m., the N.C. Department of Health and Human Services (NCDHHS) is launching a Thursday-afternoon webinar series for healthcare providers. This new weekly series, presented in collaboration with our Community Care of North Carolina (CCNC) and NC-AHEC partners, is meant to help our state’s healthcare providers address the tremendous challenges arising from the COVID-19 pandemic.For more information and to register for the webinar series, go here.


  • 3.18.20
    COVID-19 guidance and information
    With new information being released so regularly now regarding COVID-19 and the ways healthcare organizations should deal with patients who test positive or have active symptoms, we have begun consolidating informational resources from trusted sources, both for our practice partners, and for patients and the general public. Two sections of the Access East website will now be continually updated as valuable new COVID-19 information becomes available:
    We encourage you to continue to check with reputable state and federal agencies on your own for developments, but hopefully the information we are assembling may prove useful to you, and your patients, as well.


  • 2.4.20
    NC DHHS seeks provider comment on Medicaid Managed Care changes
    The two policy papers posted to the NC Department of Health and Human Services (NC DHHS) website recently both request provider feedback, due by Feb. 19, on some key areas of the upcoming Medicaid Managed Care transition. We have summarized the agency’s main requests for comment, along with some background information, in a two-page handout you can view and download here.A few additional areas where DHHS has also requested comment are not included in the handout; you will find those in the original policy papers, which DHHS strongly encourages providers to read, and which are linked through the handout.


  • 1.29.20
    What practices should be doing right now on Medicaid Managed Care
    The NCDHHS has just released back-to-back policy papers on the state’s move to Medicaid Managed Care, while stressing the need for practices to continue preparing for this major change. Here are the key points:

    • Fee-for-service is going away, and Value-Based Payment (VBP) arrangements between providers and the Prepaid Health Plans (PHPs) are coming quickly. The current hold on Medicaid Managed Care implementation does not change that.
    • It’s important that practices continue their work on quality metrics for the Advanced Medical Home (AMH) incentive program. AMH Tier 3 practices will be better positioned for the state’s transition to its planned Medicaid Accountable Care Organization (ACO) program, which will build upon AMH Tier 3 program requirements.
    • All ACOs will need to create a Healthy Opportunities Strategic Plan to help their Medicaid patients meet their non-medical needs (transportation, food, etc.).
    • Practices should look over the two NCDHHS policy papers:
    • The NCDDHS policy papers ask for feedback, due by Feb. 19, on key areas of the state’s switch to VBP; practices are strongly encouraged to take part, so that they have a voice in this huge change to N.C. Medicaid.


  • 11.20.19
    Hugely important news!
    Medicaid transformation is ON HOLD, and will NOT launch on Feb. 1, 2020, as planned.NC DHHS announced yesterday that North Carolina’s switch to Medicaid managed care has been suspended, along with open enrollment for Medicaid patients, due to holdups in Raleigh in passing a state budget.Read the state’s official announcement here: Mandy Cohen confirmed that Medicaid transformation is still expected to happen. A new launch date isn’t expected to be set at least until the General Assembly returns to session in mid-January.Nothing should change in day-to-day operations of the Medicaid program. Healthcare providers will continue to bill the state through NC Tracks, and Medicaid patients will continue getting health services as they do today.


  • 11.14.19
    Some good news for AMH Tier 3 practices
    NC DHHS has reaffirmed its support of the Advanced Medical Home (AMH) program by beefing up the state’s Prepaid Health Plan (PHP) contract with safeguards that protect and clarify the role of AMH Tier 3 practices. These safeguards are meant to protect Tier 3 practices against any immediate downgrade to a Tier 2 status, and ensure that PHPs give practices reasonable time to fix any issues the PHPs might identify.The state has also clarified that PHPs cannot hold Tier 3 practices to contract requirements that go beyond what’s necessary for practices to meet AMH Tier 3 standards.Finally, to support AMH Tier 3 practices in their contract negotiations with the PHPs, the state is reserving the right to set minimum Care Management Fees that PHPs must pay to practices. If necessary, the state can also reduce care-management funding to PHPs if it’s determined that AMH Tier 3 practices are not getting adequate financial support for delivering required AMH functions.Learn more on this here.


  • 11.14.19
    Update on the Nov. 15 PHP contracting deadline
    Tier 3 rate negotiations do not need to be completed by the Nov. 15 deadline, though they should be finished as soon as possible. However, practices that have any kind of contract in place with at least one (1) PHP, or who have signed and mailed a PHP contract by Nov. 15, will keep their active patients when auto-enrollment takes place in December.


  • 10.14.19
    Regional PHP CCH to Now Cover Nash and Wilson Counties
    Carolina Complete Health (CCH), a regional Prepaid Health Plan (PHP), has just been awarded additional counties to cover, including Nash and Wilson. If your practice is in either of those counties, or if you serve patients who live in those counties, you should strongly consider contracting with CCH as one of your PHPs.This needs to be done QUICKLY. NC DHHS has instructed that all PHP contracts need to be signed and mailed to the PHP by Nov. 15. Practices that miss this deadline risk losing un-enrolled patients when those patients are auto-assigned to a PHP on Dec. 16.Contact CCH here. Provide your practice’s TIN, NPI and Medicaid number, and a CCH team member will reach out to you within five (5) days to complete the process. You can also call CCH Network Relations at (919) 719-4161.


  • 10.11.19
    Open Enrollment to Begin for Remaining Medicaid Beneficiaries
    Open Enrollment for Medicaid Managed Care begins Monday, Oct. 14 for Medicaid beneficiaries in all counties that have not yet enrolled. Enrollment packets have already been mailed to beneficiaries to help them choose and enroll in a health plan, and to select a primary care provider from that plan’s network.Open Enrollment will end statewide Dec. 13, 2019, with Medicaid Managed Care to begin Feb. 1, 2020, across North Carolina.


  • 9.4.19
    Managed-Care Go-Live Date Extended for Phase 1 Counties
    The go-live date for the statewide transition to managed care, along with open enrollment for Medicaid beneficiaries, has officially been extended until Feb. 1, 2020, for ALL North Carolina counties. This change really only affects counties that were in the original Phase 1 of the rollout, including Wilson and Nash counties; the go-live date for counties in Phase 2 was Feb. 1, 2020, to begin with.Managed care had been scheduled to roll out in two phases, with counties in Phase 1 to have begun managed care services Nov. 1, 2019, and most of the state beginning Feb. 1, 2020. With the Sept. 3 announcement from NC DHHS, managed care is now scheduled to go live in one phase for the whole state, beginning Feb. 1, 2020.NC DHHS adjusted the timeline due to complications with the state’s current continuing-resolution budget (see the official NC DHHS announcement here).


  • 08.16.19
    CCNC Contract Ending; Interim Contract to Cover Until Go-Live
    Primary-care practices may receive a letter from Community Care of North Carolina (CCNC) to announce the Oct. 31, 2019, end of CCNC’s state contract to provide primary-care case-management (CM) services to Medicaid patients.The announcement of the contract ending is no cause for concern; this was scheduled to happen. A new contract between CCNC and the state extends CCNC’s CM services through Phase 1 and Phase 2 practices’ go-live dates (Nov. 1, 2019, for Phase 1; February 2020, for Phase 2), to prevent a lapse in CM coverage during the transition to managed care through the Prepaid Health Plans (PHPs).Access East will continue to provide its Phase 1 and Phase 2 primary-care practices with CM for their Medicaid patients, and practice support, up through the practices’ go-live date for managed care.


  • 07.18.19
    Fraudulent Email Being Sent to Providers
    NC Medicaid’s Office of Compliance and Program Integrity has issued a warning concerning a fraudulent third-party email being sent to North Carolina healthcare providers in an effort to “defraud you and the NC Medicaid program.” Providers are urged not to respond to the email, displayed here. The warning also includes additional cautions for providers, as well as further details about this specific scam effort, which falsely asserts there is a set deadline for credentialing for Medicaid Managed Care and/or a specific health plan.


  • 07.10.19
    Sign Up for NCDHHS Webcast: Medicaid/Managed Care Update
    NCDHHS will hold a webcast at 2:30 p.m. Monday, July 15, with updates on NC Medicaid managed-care implementation, including details on Phase 1 open-enrollment activities, plus an opportunity to ask questions. NCDHHS Secretary Mandy Cohen, MD, will be among the presenters. Note that REGISTRATION is required to access the webcast.


  • 07.10.19
    Phase 1 Medicaid Launch on Track for Nov. 1
    A subscriber email from NC Tracks today, on behalf of Dave Richard, Deputy Secretary for NC Medicaid, says the Nov. 1 target date for Phase 1 beneficiaries to begin using their health plans is on track, despite earlier reports of a possible delay. The message also notes that enrollment packets have begun being mailed out this week to beneficiaries in Phase 1 counties, including Nash and Wilson, and open enrollment for Phase 1 is scheduled to begin next week, on Monday, July 15.


  • 07.08.19
    Possible Delay to Medicaid Launch
    It was announced last week that a delay in approval of the North Carolina budget, coupled with concerns voiced by doctors and other providers who have yet to sign contracts with Prepaid Health Plans (PHPS), may lead state legislators to postpone the scheduled November launch date. Due to this possible delay, the mail-out of enrollment materials for patients who live in Phase 1 counties, which was originally planned to begin June 28, has not yet happened. (The enrollment broker’s website and toll-free phone number, however, are operational.) Therefore, practices that serve Phase 1 patients may want to postpone outreach to these patients until there is official word on whether the enrollment timeline will be delayed.This NC Health News story goes into more detail; scroll down to the “Delay for managed care switch?” section.


  • 07.08.19
    Judge Denies Appeals from Health Plans
    A North Carolina administrative judge last week denied appeals from three health plans — Aetna, My Health, and Optima — that were unsuccessful in their bids to be chosen as one of the Medicaid managed-care groups. These three health plans may continue to pursue their appeals within the state court system, but the judge’s order denying the injunctions suggests that the groups are unlikely to overturn the state’s current contract decisions.Check out this NC Health News story for more detail.


  • 07.08.19
    Billing Issue for Phase 2 Practices
    We have had a confirmation regarding Phase 2 practices that serve patients living in Phase 1 counties: Phase 2 practices will continue to bill via NC Tracks for all patients, including those patients living in Phase 1 counties, until those practices’ Phase 2 launch date in February 2020.