Message from the CEO - September 2019

Cardinal Innovations Healthcare — September 17, 2019
As we officially close out summer this month and jump back into routines, September finds most of us busier than ever. And while there’s value in routines and predictability, we must also focus on doing things better than we did yesterday. I’ll be the first one to say that change can be uncomfortable. But change is also a sign of growth and progress. As Ginni Rometty says, “Growth and comfort do not coexist.” The change taking place in North Carolina’s Medicaid program is the perfect example of this: it’s a lot of change taking place with the goal of progress and growth.

These changes are often collectively referred to as Medicaid Transformation, which I’ve talked about here several times. Medicaid transformation is a system-wide reform that will move most of North Carolina’s Medicaid benefits to a managed care model. Under Medicaid transformation, people who qualify for Medicaid in NC will now have most of their health benefits, including physical, behavioral, and pharmacy benefits, managed by one Medicaid health plan. NC Medicaid Managed Care plans, also known as “standard plans,” are health plans that will cover physical, behavioral, and pharmacy benefits for the majority of Medicaid enrollees under Medicaid transformation. On July 1, 2021, LME/MCOs will become “tailored plans” and will administer physical, behavioral and pharmacy benefits for Medicaid enrollees with the most complex behavioral health and IDD needs.

Executing changes of this scale involves a lot of different factors, and even one unexpected shift can affect the entire timeline. On that note, I want to be sure you’re aware of the most recent news about Medicaid Transformation. Earlier this month, the agency in charge of overseeing Medicaid Transformation, the NC Department of Health and Human Services (NC DHHS), announced that it will delay the November 1 go-live date for Standard Plans until February 1, 2020.

This means that all 100 counties across North Carolina will implement Medicaid managed care on the same date rather than in two phases. This should not impact the July 2021 timeline for Tailored Plans.

If you have questions about Medicaid Transformation and how this impacts you and your family, I encourage you to visit or call the enrollment broker at 1-833-870-5500. You can also talk to your provider or care coordinator. Additionally, we’ve created a Medicaid Transformation Q&A document with even more information based on the questions we received from members and families at recent town hall sessions.

Again, Medicaid Transformation that’s taking place in North Carolina is change on a pretty massive scale, but with the right approach, it holds the promise of growth, progress, and, ultimately, better health outcomes for those we serve.
 Trey Sutten, CEO

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