Jay Ludlam – Assistant Sec., NC Medicaid
Commonwealth North Presentation
North Carolina’s Vision for�Medicaid Transformation
“To improve the health of North Carolinians through an innovative, whole-person centered, and well-coordinated system of care that addresses both the medical and non-medical drivers of health.”
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North Carolina’s Vision for�NC Medicaid Managed Care
“To improve the health of North Carolinians through an innovative, whole-person centered, and well-coordinated system of care that addresses both the medical and non-medical drivers of health.”
Transition to Medicaid Managed Care�
The North Carolina Department of Health and Human Services (DHHS) has collaborated with clinicians, hospitals, beneficiaries, counties, health plans, elected officials, advocates and other stakeholders to shape the program, and is committed to:
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Whole-person care - through the coordination of services addressing physical health, BH, I/DD, TBI, long-term services and supports (LTSS), pharmacy, and unmet health-related resource needs with the goal of improved health outcomes and more efficient and effective use of resources
Provider access - Maintaining broad provider participation in NC Medicaid by removing or mitigating provider administrative burden from the health delivery system
Buy health - Uniting communities, providers and health care systems to address the full set of factors that impact health while deploying cost-effective resources that are needs-based and outcomes driven
Local care management - Overseeing a transition to provider-based care management at the site of care, in the home or in the community to promote in-person interaction with members
Member experience - Improving the Medicaid Managed Care member experience with a simple, timely, and user-friendly eligibility and enrollment process focused on high-quality, Culturally and Linguistically Appropriate Services
NC Medicaid Transformation | February 2022
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All health care options, all regions went live on July 1, 2021
Approximately 1.6 million of the current 2.5 million Medicaid beneficiaries will transition to NC Medicaid Managed Care
Moving to NC Medicaid Managed Care�
NC MEDICAID MANAGED CARE | NC MEDICAID TRANSITION TO MANAGED CARE | DATE
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A health care option coordinates your health care with your doctors, hospital and other providers. They work together to provide beneficiaries with health care, including physical and behavioral health services and medicine prescribed for you.
New Health Care Options
Behavioral Health I/DD Tailored Plan |
Behavioral Health I/DD Tailored Plans will provide the same services as Standard Plans, as well as additional specialized services for individuals with significant mental health and substance use disorders, I/DDs and traumatic brain injury (TBI), as well as people using state-funded and waiver services. |
EBCI Tribal Option |
The Eastern Band of Cherokee Indians (EBCI) Tribal Option will be available to tribal members and their families and will be managed by the Cherokee Indian Hospital Authority (CIHA). |
Standard Plan |
Standard Plans will provide integrated physical health, behavioral health, pharmacy, and long-term services and support to most Medicaid beneficiaries, as well as programs and services that address other unmet health related resource needs. |
NC MEDICAID MANAGED CARE | NC MEDICAID TRANSITION TO MANAGED CARE | DATE
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