N.C. Delays Transition to Managed Care Due to Budget Standoff

The state says it will move to managed care in one phase in February rather than beginning the process on Nov. 1.

Thanks to a budget standoff between its Democratic governor and a Republican-led legislature, North Carolina will delay its statewide transition to a managed care system from November to February.

The original plan was to implement a staggered rollout and offer managed care services for Medicaid recipients in two regions of the state on Nov. 1. But the Tuesday announcement by the North Carolina Department of Health and Human Services means that the entire state will transition from a fee-for-service system to managed care in one phase on Feb. 1, 2020.

In addition, the department said it would extend open enrollment for Medicaid beneficiaries in the 27 counties where the managed care transition was meant to begin in November. Residents in those counties can continue to choose which managed care company to sign up with through Dec. 13. The enrollment period in North Carolina’s remaining 73 counties will begin on Oct. 14 and end in mid-December as well.

Mandy Cohen, the secretary of NCDHHS, told reporters Tuesday that there needs to be a budget in place by mid-November, at the latest, for the state to meet the Feb. 1 deadline. Lawmakers have been at an impasse over the budget since June due to Gov. Roy Cooper’s demand that Republicans include a Medicaid expansion in the budget they send to his desk.

“Sometimes we don’t get the ideal, we have to work in the practical realities of what we have,” Cohen said regarding the one-phase transition, according to North Carolina Health News.

She added that the delay will cause no financial penalties and does not indicate that the government’s commitment to managed care has waned. Rather, Cohen said, the budget standoff meant that the state was not prepared for the major rollout just yet.

Beth Bowen, the executive director of the Atlantic Coast Medical Equipment Services Association (ACMESA), and other healthcare stakeholders across the state agreed with Cohen’s assessment. 

“The transition to managed-care is the most significant change ever undertaken by NC Medicaid," Bowen said. "For the past four years, the Department has achieved significant milestones to keep the state on track for launch of the program. ACMESA continues to communicate with the Department to ensure a strong provider community and ultimately reliable care for the beneficiaries.”

Medicaid is one of the largest health care providers in North Carolina, with 2.1 million residents dependent on the program for services. Over half of those recipients are children, according to statistics collected by North Carolina Health News.

About the Author

Haley Samsel is the Associate Content Editor of HME Business and Mobility Management.

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