Get Help Enrolling In A NC Medicaid Standard Plan
What is Medicaid Transformation?
– The intent of North Carolina Medicaid Transformation is an effort to provide more ‘whole-person’ care that includes physical and behavioral health.
– All while offering services in as cost-effective way as possible.
– Medicaid services will be delivered in a new way – through a health insurance plan that Medicaid participants will need to sign up for.
– Participants will need to sign up for a Standard Plan in 2019/20 OR a Tailored Plan (2021/22 estimate).
– Participants currently receiving more specialized behavioral health (including services for people with intellectual and/or developmental disabilities) will continue receiving services coordinated by their current North Carolina LME/MCO, and will sign up for a Tailored Plan when they become available.
Keep reading to learn more about plans, enrollment windows, help through an enrollment broker, and more.
Will Your Services With RHA Be Impacted?
– Our goal is that you are not impacted. RHA is working diligently to ensure you will still receive the same high-quality services and supports that you do today, regardless of your insurance.
– RHA is working to be an approved provider for all NC Medicaid insurance plans.
– As of mid-July 2019, RHA Health Services may not be showing up as an approved provider when you contact the Enrollment Broker. This is because agreements with these health plans are not yet finalized.
Standard Plans vs. Tailored Plans
– Standard Plans go live (depending on region) either November 1, 2019 or February 1, 2020. More information, below.
– The Standard Plan covers physical health, as well as some basic behavioral health services and will cover ~1.6 million Medicaid managed care beneficiaries.
– Tailored Plans will cover specialty behavioral health (including intellectual/developmental disabilities) services in future years.
– Tailored Plans, designed for certain populations with more specialized behavioral health needs, won’t be available for a few years.
– For a list of services available in the future Tailored Plans, view the Frequently Asked Questions – PHP member enrollment (PDF).
– For now, these services will be coordinated by your current North Carolina LME/MCO.
NC Enrollment Broker and How it Works for Medicaid
NC Medicaid held a statewide webinar (view the Recording or the Presentation slides) on Tuesday, June 25, 2019, 1-2:30 p.m. regarding the NC Enrollment Broker Maximus, who will be helping with the implementation of Medicaid Managed Care. Topics covered in the webinar include:
– The NC Medicaid Managed Care transition and its impact on beneficiaries
– The timeline for open enrollment for Standard Plans and what to expect in terms of communication to beneficiaries
– How you can partner with the Enrollment Broker to educate beneficiaries.
Enrolling in a Standard Plan
Prepaid Health Plan (PHP) Enrollment Letters
– Frequently Asked Questions – PHP member enrollment (PDF)
– Understand letters sent to NC Medicaid members. This letter should tell you whether you are qualified on the Standard Plan or the Tailored plan.
– Contact info for Maximus, company responsible for helping members select and enroll in a health plan
– Guidance in choosing the right plan for you
– List of services covered: 1) Exclusively by Tailored Plans or 2) Covered by BOTH Standard Plans and Tailored Plans
3 Important Steps For Persons Receiving Services
If you currently receive NC Medicaid, you will receive communications to walk you through 3 steps:
1) Choose your Primary Care Provider (family doctor clinic, etc.) for each NC Medicaid member
2) Choose a Health Plan (you can pick a plan that your current doctor works with)
3) Enroll online, by phone or mail.
3 Way To Enroll in a Standard Plan
1) Online – Visit ncmedicaidplans.gov – Learn | Choose | Enroll. Use the NC Medicaid Managed Care mobile app. To get the free app, search for NC Medicaid Managed Care on Google Play or the App Store.
2) Call 1-833-870-5500 (TTY: 1-833-870-5588)
3) Mail the enrollment form in the envelope that came in your initial letter, or fax it to 1-833-898-9655
What Is The Open Enrollment Window to select a standard plan?
Region 2 or 4 | Enroll July 15 – September 13, 2019
– If beneficiaries doesn’t enroll by Sept 13, they will be auto-assigned to a plan on Sept 16.
– Health Plan will be available November 1, 2019
Region 2 & 4 Counties: Alamance, Alleghany, Ashe, Caswell, Chatham, Davidson, Davie, Durham, Forsyth, Franklin, Granville, Guilford, Johnston, Nash, Orange, Person, Randolph, Rockingham, Stokes, Surry, Vance, Wake, Warren, Watauga, Wilkes, Wilson, Yadkin
Region 1, 3, 5, or 6 | Enroll by October 14 – December 13, 2019
– If beneficiaries doesn’t enroll by Dec 13, they will be auto-assigned to a plan on Dec 16.
– Health Plan will be available February 1, 2020
Region 1, 3, 5, & 6 Counties: Alexander, Anson, Avery, Beaufort, Bertie, Bladen, Brunswick, Buncombe, Burke, Cabarrus, Caldwell, Camden, Carteret, Catawba, Cherokee, Chowan, Clay, Cleveland, Columbus, Craven, Cumberland, Currituck, Dare, Duplin, Edgecombe, Gaston, Gates, Graham, Greene, Halifax, Harnett, Haywood, Henderson, Hertford, Hoke, Hyde, Iredell, Jackson, Jones, Lee, Lenoir, Lincoln, McDowell, Macon, Madison, Martin, Mecklenburg, Mitchell, Montgomery, Moore, New Hanover, Northampton, Onslow, Pamlico, Pasquotank, Pender, Perquimans, Pitt, Polk, Richmond, Robeson, Rowan, Rutherford, Sampson, Scotland, Stanly, Swain, Transylvania, Tyrrell, Union, Washington, Wayne, Yancey
- Visit the NC Dept. of Health & Human Services Medicaid Transformation website
- View the ‘County Playbook’, which is an overview of the transition to Medicaid Managed Care with information to help guide a person through the transition.