Medicaid Transformation in North Carolina

North Carolina hospitals and health systems support the on-going efforts to reform the Medicaid program and urge the General Assembly to pass legislation that ensures providers are able to practice within the Medicaid population without undue burden from regulators or insurance companies.

Background Information

The following archive provides context for the NCDHHS process for Medicaid transformation in North Carolina. It includes RFP information and NCHA comment documents.

August 9, 2018

DHHS released its RFP for Medicaid managed care plans today, along with additional fact sheets about Medicaid managed care. The information can be found on the NC DHHS Medicaid Transformation page. DHHS expects to award managed care plan contracts in February, 2019, begin managed care in certain regions in November, 2019 (Phase I), and implement for the rest of the State in February, 2020 (Phase II).  Enrollment will begin several months before those dates.  The Phase I regions likely will not be determined until early 2019. NCHA will be scheduling webinars and other sessions in the near future to help members prepare for the transition to Medicaid managed care. If you have any questions, please feel free to contact Linwood Jones.

September 8, 2017

NCHA provided a response on behalf of members to the NC Department of Health and Human Services’ latest version of the Medicaid Managed Care Program Design document, which was made public by NC DHHS on August 8. In addition, you can read the joint letter to Secretary Mandy K Cohen that was submitted with the proposal on behalf of NCHA and the North Carolina Medical Society. The response included a proposed redesign of the Medicaid Reimbursement Initiative/Gap Assessment Program  that was developed by NCHA’s MRI/GAP Technical Advisory Committee, comprised of approximately 20-member hospital chief financial officers and reimbursement directors. The proposal was reviewed during a member webinar on August 24 and was approved by the Board on August 25, 2017. Preserving supplemental payments has been a priority for NCHA because they represent critical funding to preserve our state’s healthcare safety net. In 2017 alone, more than $800 million in net MRI/GAP payments have been made to NCHA member hospitals.

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