Medicaid Managed Care


On July 1, 2021 North Carolina’s Medicaid program transitioned from a fee-for-service (FFS) delivery system to a managed care delivery system. Under the fee-for-service model, the Department of Health and Human Services (DHHS) reimbursed physicians and health care providers based on the number of services provided or the number of procedures ordered. This model will now be known as NC Medicaid Direct. Only a small percentage of beneficiaries will stay in Medicaid Direct. Under Managed Care, the State is contracting with insurance companies, called Health Plans. These insurance companies will be paid a capitated rate, which is a pre-determined set rate per person to provide health care services.

This delivery system is drastically different from the previous FFS system. Reimbursement is also drastically different from the previous reimbursement as the MRI/GAP plan will no longer exist. As such, NCHA is taking numerous steps to help its members succeed in Medicaid managed care.

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