North Carolina Medicaid Transformation: Medicaid Enrollment

Posted by The Arc of North Carolina

This blog series will address topics related to Medicaid Transformation to help answer questions and give you the most current information.

Monday, October 14th marked the next step in Medicaid Transformation in North Carolina. Open enrollment in the Medicaid managed care plan, or “Standard Plan,” is now available statewide.

We want to help you better understand Medicaid Transformation, so let’s talk about the enrollment process.

Enrollment is a process that allows each Medicaid recipient in the Standard Plan to choose a health insurance company/managed care organization to manage their Medicaid-funded medical services.

If you need to enroll in the Standard Plan (SP), the state has contracted with an enrollment broker, Maximus, to handle enrollment. They are a global company and handle enrollment in managed care in many states. Their staff is available to help people understand the differences between insurance companies and decide which one to go with for their health care management.

The state began mailing letters in early July to people in regions 2 & 4. (A person's Medicaid home county determines which region they are in for these purposes.) Since the entire state will now roll into the Standard Plan in February 2020, rather than regions 2 & 4 starting early, DHHS has mailed enrollment letters to the remaining people who are expected to be identified for the Standard Plan. (If you are receiving Innovations Waiver services, you should not be receiving a letter about enrolling in the Standard Plan. You are being held out of this transition and will be moved into a Tailored Plan in 2021. We will provide more information about Tailored Plans as it becomes available.)

Open enrollment ends on December 13, 2019, and after that date anyone who is supposed to move into the Standard Plan and has not enrolled with one of the health plans will be auto-assigned to a health plan by the state. New NC Medicaid Health Plans begin operation on February 1, 2020.

Please be aware that if you are currently receiving community-based services from The Arc of North Carolina or any other organization and you choose to move to one of the health plans, you will LOSE all of your current services. This will happen because those insurance companies, or health plans, will only manage medical services, and they will NOT have funds for the community-based services you are receiving now. You will be moved into the Tailored Plan, with more customized services like the ones you are receiving, in 2021.

If you have questions about open enrollment, you can call the Medicaid Managed Care Call Center at (833) 870-5500 or visit ncmedicaidplans.gov

Click here for Medicaid Transformation Resources.