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Medicaid Managed Care February Start Date Delayed

Edgecombe County

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 November 22nd 2019 

Medicaid Managed Care February Start Date Delayed 

The Department of Health and Human Services (DHHS) announced this week that because the General Assembly did not take needed action, managed care implementation and open enrollment for NC Medicaid will be delayed. The General Assembly adjourned last week without providing required new spending and program authority for the transition to managed care. Managed care will not go live on February 1, 2020.

With managed care suspended, NC Medicaid will continue to operate under the current fee-for-service model administered by the Department. Nothing will change for Medicaid beneficiaries; they will get health services as they do today. Below are a list of questions and answers Medicaid beneficiaries may have. 

1. "I got a letter telling me I had to pick a health plan. I'd like to sign-up with [Health Plan Name]. My doctor said they are accepting that plan.”

You do not need to choose a health plan today because the State's move to Managed Care is on hold. The State will tell you when Managed Care restarts and when you will need to choose a health plan. At this time, you will keep getting your Medicaid coverage and health services from the State the way you do now. You will keep the primary care provider (PCP) you have now. You will get a letter in the mail. It will confirm that you will keep the Medicaid coverage you have now.

2. When will Medicaid transition to managed care? When will Managed Care restart? When will my health plan start?

For now, the move to Managed Care is on hold. The State will tell you when it restarts and when you will need to choose a health plan.

3. How does this affect my Medicaid coverage?

At this time, your coverage will stay the same. You will keep getting your Medicaid coverage and health services from the State You will keep the primary care provider (PCP) you have now. If you are currently receiving services from LME-MCOs, you will continue to get those services. You will get a letter in the mail. It will confirm that you will keep the Medicaid coverage you have now.

4. Do I need to do anything right now?

No. You do not need to do anything now. You do not need to choose a health plan. You will keep getting your Medicaid coverage and health services from the State the way you do now. You will get a letter in the mail. It will confirm that you will keep the Medicaid coverage you have now. The State will tell you when Managed Care restarts and when you will need to choose a health plan.

5. Can I still see my doctor?

Yes. You can go to the primary care provider (PCP) listed on your Medicaid card. If you want to confirm the name of the PCP listed or change to a new PCP, call the North Carolina Medicaid Contact Center at 1-888-245-0179. Or call your DSS county caseworker.

6. What if my Medicaid coverage is set to end (recertification) before Managed Care restarts?

If your coverage is set to end before Managed Care restarts, your Medicaid coverage will go through the same yearly eligibility review and recertification process used today.

7. What if I already picked a health plan? Will I have to pick a plan again?

Yes. You will need to pick a health plan once Managed Care restarts even if you previously picked a health plan. The State will tell you when Managed Care restarts and when you will need to choose a health plan.

8. What if I already picked a health plan? Do I still get the extra benefits I was offered?

No. You will not move to a health plan now, so you will not get any added services the health plan offers. You will keep the same Medicaid coverage and health services from the State that you have today.

9. I selected a new doctor with my health plan, do I have to choose a different one now?

Since the State's move to Managed Care is on hold, you will keep getting your Medicaid coverage and health services from the State the way you do now. You will keep the primary care provider (PCP) you have now listed on your Medicaid card. If you would like to confirm who is listed as your primary care provider or change your primary care provider, call the Medicaid Contact Center at 1-888-245-0179 or DSS county caseworker.

10. Do I still need to enroll while Managed Care is on hold? Can I still pick a plan or primary care provider for my health plan while Managed Care is on hold?

No. You cannot choose a health plan or primary care provider for a health plan at this time. The State will tell you when Managed Care restarts and when you will need to choose a health plan.

11. Why was Managed Care delayed? Why did this happen?

Legislators did not take actions needed to move forward with managed care, so Managed Care can't go-live at this time. You will continue to get health services as you do today through Medicaid Direct.

12. Will Managed Care ever restart/happen?

Managed Care is on hold at this time until further notice. The State will tell you when Managed Care restarts and when you will need to choose a health plan.

13. Will the enrollment broker call center continue to be available to take calls if I have questions?

Yes, you can call the Enrollment broker at 833-870-5500 (TTY: 1-833-870-5588) Hours of operation: 7 a.m. to 5 p.m., six (6) days a week

14. Will I still go to my LME-MCO for BH/IDD benefits?

Yes. If you are currently receiving services from an LME-MCO, you will continue to get those services.

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