Update on Medicaid Enrollment

Posted by The Arc of North Carolina

We are re-launching our blog series on Medicaid Transformation. The series will address topics related to Medicaid Transformation, answer questions, and give you the most current information.

North Carolina Department of Health and Human Services continues moving forward with the implementation of NC Medicaid Managed Care. In March 2021, open enrollment for the Standard Plan began and will close on May 15, 2021. The Standard Plan will go live on July 1, 2021. If you are not familiar with the Standard Plan, it is like an insurance company that has a “standard” set of services for people who have basic medical and health-related needs. It does not have the kinds of community services you might receive now.

Medicaid recipients will then choose a Health Plan from 4 or 5 options (depending on where you live), including: Healthy Blue (BCBS), AmeriHealth Caritas, WellCare, United HealthCare, and Carolina Complete Health (only available in certain counties).

Tailored Plan (TP) is a plan for how the state will manage costs for health and medical services for a "tailored" population with more intense needs. Most people with IDD, severe mental illness (MI) and severe substance use (SU) disorders will be covered under the Tailored Plan, which goes live in July 2022. This is the state's way of combining the long-term services and supports for this group with their medical services under managed care.

Please be aware that if you are currently receiving services from The Arc of North Carolina or any other organization and you choose to move to one of the Standard 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 services you are receiving now.
We are hearing from self-advocates and families who are receiving letters from their doctor telling them that they need to sign up for the Standard Plan. If you are receiving services from The Arc of North Carolina or another organization, you do not have to do anything. You will be automatically moved to the Tailored Plan in July 2022.

If you enrolled in the Standard Plan and want to have the Tailored Plan instead, you can fill out the Raise Your Hand form to get help in making that change.

In April 2021, The Arc of North Carolina hosted a webinar, Medicaid Transformation 101, with a question-and-answer session to discuss the changes to Medicaid and how they will affect people with IDD.

You can find the webinar here: https://www.youtube.com/watch?v=zpRVZ7Sa5zk 

And the questions and answers are here: https://arcnc.org/images/Medicaid%20Transformation/MT-Webinar-Questions-and-Answers_May%202021.pdf 

If you have questions regarding the services you receive or how Medicaid Transformation will affect you, contact the North Carolina Medicaid Enrollment Broker at 833-870-5500. You may also contact your LME-MCO or The Arc of North Carolina at 1-800-662-8706 or info@arcnc.org.