North Carolina Releases Design for Medicaid Managed Care

The North Carolina (NC) Department of Health and Human Services released a detailed proposed design for transforming the state Medicaid and NC Health Choice programs to managed care. “We have put forward a detailed proposed design for a Medicaid managed care system that will deliver an innovative, whole-person-centered, well-coordinated system of care,” said Dr. Mandy Cohen, Secretary of DHHS. “We are grateful for the thoughtful insights provided by hundreds of health care professionals, beneficiaries and other stakeholders, and DHHS welcomes feedback on this proposal.”

Highlights of the paper include:

  • A timeline for transition of key functions and highlights how managed care can meet the needs of complex populations. 
  • How certain aspects of the Medicaid program, like beneficiary appeals and care management, will transition under managed care.
  • How providers and plans will contract with each other consistent with protections in North Carolina law.
  • How data will move through the system, and
  • How DHHS will hold plans accountable for meeting standards and delivering high quality care.