Medicaid Transformation

20140917_untitled0134How North Carolina is Transforming the Medicaid Program

Since 2015, when the North Carolina General Assembly passed legislation to move the state’s Medicaid program to managed care, the NC Department of Health and Human Services (NC DHHS) has been working to make this major transition. This is the most significant change to the state’s Medicaid program in 40 years and is a lengthy and complex process. As the state’s oldest professional society and largest organization representing physicians and PAs, the North Carolina Medical Society (NCMS) has long played an integral role in representing our members’ interests around Medicaid, and we will continue to participate on behalf of our members in a meaningful way. This page offers information on the latest developments in the Medicaid transformation process. Check back frequently for updates.

Message from the NCMS on the recent Medicaid managed care contract awards to Pre-Paid Health Plans

As you most likely know from news reports, the NC Department of Health and Human Services (NCDHHS) has awarded four statewide contracts and one regional contract to manage the state’s Medicaid program, part of the transformation to Medicaid managed care set in motion with legislation back in 2015.

The North Carolina Medical Society (NCMS) is pleased that Carolina Complete Health, a joint venture between the NCMS and Centene Corporation and the North Carolina Community Health Center Association, received the contract to serve regions three and five, which encompasses 27 counties extending from Charlotte along the southern portion of the state to the coast.

As always, the NCMS will continue to advocate for you on issues surrounding Medicaid as it has for decades. Our business relationship with Carolina Complete Health, while founded on our shared values of improving community health and physician leadership, does not in any way preclude our longstanding responsibility to represent your best interests in all matters related to your practice at the legislature, at regulatory agencies and with other stakeholders.

“The NCMS has been around for 170 years representing you and your patients in ever evolving ways that reflect the distinctive challenges and opportunities of the particular time,” said NCMS CEO Robert W. Seligson. “We are excited to be part of Carolina Complete Health, which offers new opportunities to help shape the state’s Medicaid program in a fashion that best serves your patients and you. Our lasting legacy of supporting your profession is due to the NCMS’ willingness to embrace new ideas and adjust to changes in inventive ways, while remaining true to our core values of improving patient health and physician leadership.”

The NCMS’ partnership with Centene is unique. The NCMS trusts that this innovative patient-focused, physician-led arrangement will ultimately help achieve our goal of improving health for our most vulnerable citizens.

This award announcement is only the next major step in what is a long journey toward Medicaid managed care for the state.  The next milestone will come in November, the anticipated ‘go-live’ date for the statewide plans when Medicaid beneficiaries will begin to receive benefits. Regions three and five are anticipated to begin operation in February 2020. Be sure to watch the NCMS Morning Rounds for updates on Medicaid transformation as well as other news of importance to you and your practice.

More Information from NC DHHS:

Carolina Complete Health and the NCMS

The NCMS is part of Carolina Complete Health, a joint venture between the NCMS, Centene Corporation and the North Carolina Community Health Center Association (NCCHCA). Learn more about Carolina Complete Health and Carolina Complete Health Network.

The NCMS’ Long Involvement in Medicaid Reform

The North Carolina Medical Society (NCMS) has been an integral part of North Carolina’s Medicaid reform process — from our response to the state’s initial request for proposals in 2013 to the submission of the waiver request to the Centers for Medicare and Medicaid Services (CMS) on implementing the General Assembly’s reform legislation in 2016 to the recent award of Medicaid contracts. We will continue to participate in a meaningful way in this process on behalf of NCMS members and their patients.

History of NC Medicaid Reform

As the General Assembly debated on how to reform the state’s Medicaid program beginning in 2013, the NCMS developed a series of key principles to guide our advocacy. They were:

  • Put the patient at the center, making certain the whole person is cared for, factoring in community services as necessary to sustain the person’s health.
  • Be led by physicians since they have the clinical knowledge to understand what constitutes excellent patient care.
  • Use quality performance measures that are meaningful, consistent across all entities, clinically relevant and are not an additional burden to physicians.
  • Be transparent in reporting data, quality measures, costs and savings.
  • Strive for administrative simplicity during the transition period leading to sensible and streamlined procedures once the system is in place.
  • Establish network adequacy standards to ensure access to care based on federal law or regulations.

Many of these principles were incorporated into the final Medicaid reform legislation passed in 2015.

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