In 2015, the North Carolina General Assembly enacted legislation (Session Law 2015-245), directing the transition of Medicaid from predominantly fee-for-service to a managed care structure.  The North Carolina Department of Health & Human Services (DHHS) seeks to implement Medicaid Managed Care (MMC) in such a way that advance high-value care, improves population health, engages and supports providers, and establishes a sustainable program with predictable costs.

As our state works toward implementation, the North Carolina Department of Health & Human Services (DHHS) has released the Medicaid Managed Care (MMC) Prepaid Health Plans (PHPs) request for proposals (RFP) and the department has entered a “period of silence” until contracts are awarded through a competitive bidding process. This period of silence has been implemented to avoid unfair advantage to any one submitter and is expected to last until contracts are awarded this month.

While the Centers for Medicare & Medicaid (CMS) has not yet approved the state’s request to implement Medicaid Managed Care (MMC), that approval is expected. The state continues to move forward with MMC with a phased-in approach, targeted for early 2019. DHHS has awarded Maximus Inc. the enrollment broker contract for the state.

GAO and our internal advisory workgroup continue to provide feedback to Medicaid to protect and ensure access to quality home care as North Carolina moves toward Medicaid Managed Care.

If you have any question or concerns about Medicaid reform, contact  me at [email protected].