DHHS Update on Tailored Plan Beneficiaries

Cardinal Innovations Healthcare — June 16, 2021
We are continuing to move forward with preparations to launch NC Medicaid Managed Care on July 1. The well-being of the beneficiaries will remain the top priority during this transition.

The NC Department of Health and Human Services (NCDHHS) gathered data during the Open Enrollment period that showed none of the Tailored Plan-eligible beneficiaries were auto-enrolled in a Standard Plan. Through June 1, about 7,000 beneficiaries made an active selection to enroll in Standard Plans.

NCDHHS determined that it would be beneficial to provide Tailored Plan-eligible beneficiaries who enrolled in a Standard Plan with more information. They want to ensure that these beneficiaries are fully aware of the impact of their decision to leave NC Medicaid Direct and their LME-MCO. For instance, enrolling in a Standard Plan may cause them to lose services.

NCDHHS has decided to stop Standard Plan enrollments of these beneficiaries. All Tailored Plan-eligible beneficiaries who selected a Standard Plan will remain in NC Medicaid Direct and their LME-MCO through NC Medicaid Managed Care GoLive on July 1, 2021.

A notice will be sent to the beneficiaries later this month to notify them of the change. It will also include a detailed list of services that are not available in a Standard Plan.

NCDHHS will still allow Tailored Plan-eligible beneficiaries to have the option to enroll in a Standard Plan. They plan to implement a specific enrollment process  that will include enhanced choice counseling by early August. This will help verify that beneficiaries have all the information they need to make an informed, appropriate decision.

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