North Carolina’s Efforts Towards Medicaid Transformation Continue to Move Forward

The General Assembly passed two bills, H. 403  and H. 156,  which work together to clarify the implementation of the Standard and Behavioral Health/Intellectual-Developmental Disability (BH/I-DD) Tailored Plans and the licensure requirements for Prepaid Health Plan (PHP) managers under Medicaid Transformation.

In a historic move, legislators voted to move Medicaid recipients with mild-to-moderate behavioral health needs under the Standard Plan for Medicaid services. Individuals with a serious mental illness, a serious emotional disturbance, a severe substance use disorder, an intellectual/developmental disability, US DOJ settlement consumers, or individuals who have survived a traumatic brain injury are the defined population that will fall under the Tailored Plan.

The BH/I-DD Tailored Plan will begin one year after the Standard Plan with the LME/MCOs as the lead plan managers working with another PHP to offer the physical healthcare services for Tailored Plan Medicaid recipients for four years after that. The timelines incorporated in these bills push for North Carolina to complete the transition to the Standard and Tailored Plans as well as moving other specialty populations under managed care within five years of CMS approval.

GAO and our internal advisory workgroup continues to provide feedback through stakeholder involvement to ensure access to quality care as North Carolina moves toward Managed Care. If you have any questions about this process or the future of Medicaid in our state, please email me at ldobson@bayada.com.

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