What is Managed Care?

Medicaid Managed Care is a way of managing Medicaid benefits.

Under a Managed Care plan, a person eligible for Medicaid benefits would be paired with an insurance provider. Healthcare services would still be covered by Medicaid, but the services and coverage would be processed and managed by an insurer.
 

How does this hold impact Managed Care?

With managed care suspended, NC Medicaid will continue to operate under the current fee-for-service model. Nothing will change for Medicaid beneficiaries; you will get health services the same way you do today.

Today, most Medicaid recipients receive coverage directly from the state of North Carolina or receive behavioral health or IDD coverage from a Local Management Entities/Managed Care Organizations (LME/MCOs), like Cardinal Innovations.

If you’re currently a Cardinal Innovations member (or a member of another LME/MCO), your services and coverage are not changing—you will stay with your current LME/MCO.
 

Do I still need to choose a health plan?

No. Your Medicaid services will remain the same.

Over the summer, you may have received a letter about choosing a health plan. Beneficiaries no longer need to choose a health plan.

You will remain with the same Medicaid coverage you have today. If or when the Medicaid Managed Care changes restart, the state will inform beneficiaries to choose a health plan again if needed.

For questions about Medicaid Managed Care or your current coverage, call the Medicaid Contact Center at 1-888-245-0179.
 

What should providers know?

All health providers enrolled in Medicaid are still part of the program and will continue to bill the state through NCTracks. Auto-assignment is currently suspended. Providers should continue to work with health plans.

For questions about Medicaid Managed Care, call the Medicaid Contact Center at 1-888-245-0179.
 

What is Medicaid Transformation?

The state of North Carolina has been working to improve its Medicaid system. These changes have been part of a greater movement often called Medicaid Transformation. Managed Care is one aspect of Medicaid Transformation that was intended to improve access to integrated care—physical, mental and behavioral, and pharmacy services—under one managed health plan.

 

What’s next?

As NC Medicaid updates come in, we’re here to help you find support and stay informed. For the latest updates, please continue to check this page and our News page.

 

Resources: 

Apply for Medicaid in North Carolina  

Get Answers from NC DHHS

Medicaid Managed Care Questions and Answers for Beneficiaries 

North Carolina Department of Health and Human Services (DHHS) 

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