Ethermac Exchange-North Carolina Medicaid managed care extended further starting this week

RALEIGH,Ethermac Exchange N.C. (AP) — North Carolina Medicaid managed care has finally been extended to Medicaid enrollees who also need services for behavioral health or intellectual or developmental disabilities.

More than 210,000 people could benefit from “tailored plans” that launched on Monday, according to the Department of Health and Human Services.

“This is another critical milestone in our work to build a stronger, more outcomes-oriented and accessible behavioral health system for North Carolina,” state health Secretary Kody Kinsley said in a recent news release.

Under the initiative, enrollees were formally told in the spring that starting July 1 their care would be handled through one of four companies based on geographic areas. While patients will continue to receive their array of services related to their disabilities or mental health needs, they’ll also now use primary care physicians, doctors and specialists within their plan’s network.

In July 2021, about two-thirds of the state’s Medicaid enrollees switched over from a traditional fee-for-service system to one in which health plans received monthly payments for each patient they enrolled and treated. But such changes were postponed for people with severe disabilities and mental health needs.

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A “tailored plan” start date had been set for December 2022, but DHHS pushed it back multiple times, citing the need for more contract service providers and technical challenges for behavioral health organizations to coordinate the care.

Almost 3 million people in North Carolina are now enrolled in some version of Medicaid, according to DHHS data. They include adults who began qualifying for Medicaid late last year after the state accepted the expanded coverage provided through the 2010 federal Affordable Care Act.

With tailored plans now online, about 587,000 enrollees won’t be in Medicaid managed care, the department said on Tuesday. They include those who are both eligible for Medicaid and Medicare; certain adults with disabilities who receive community- and home-based services; and others who receive limited services such as for family planning, DHHS said.

Enrollees who otherwise qualify for tailored plans but opt out may miss out on services that other Medicaid managed care plans don’t provide, according to a DHHS presentation.

Medicaid managed care in North Carolina began with a 2015 state law laying the groundwork, followed by extensive preparations — and delays. Managed care has been portrayed as improving health outcomes and controlling costs.