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The Pulse

  • Medicaid Transformation Update

    On August 9, as directed by legislation in 2015 to convert the state’s Medicaid program from fee-for-service to managed care, NC DHHS released the request for proposal for organizations wishing to participate in the state’s Medicaid program as “Prepaid Health Plans (PHPs).” The PHPs chosen through the RFP process will be responsible for delivering services in the managed care model – they will assume all financial risk and providers will directly contract with the PHPs to provide services to beneficiaries. Contracts will be awarded on February 4, 2019 and it is expected that Phase 1 of Medicaid managed care will begin in November 2019.

     

    NC DHHS stated that this will be the largest RFP in the agency’s history, and is being released after three years of collecting feedback and information from beneficiaries, providers, hospitals, policymakers, beneficiaries, advocates, and health plans. According to NC DHHS Secretary Mandy Cohen, M.D., North Carolina is the largest state in the nation that is yet to reform their Medicaid program from fee-for-service to managed care.

     

    As discussed in further detail in the Prepaid Health Plan Request for Proposal Fact Sheet, there are five overarching goals of this RFP:

    1. Create an innovative, integrated and well-coordinated system of care.
    2. Support clinicians and beneficiaries during and after the transition.
    3. Promote access to care.
    4. Promote quality and value.
    5. Ensure a successful managed care program.

     

    On August 9, NCAPA attended a call with stakeholders from across the state to hear an update from the NC Department of Health and Human Services on the status of the Medicaid transformation process. As the Medicaid reform process continues to move forward in North Carolina, NCAPA will be monitoring the process and working with fellow stakeholders and DHHS, as appropriate.

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