NC Medicaid Transformation

A collage of photos of patients and medical service providers

Amended Section 1115 Demonstration Waiver Application

The Department of Health and Human Services (DHHS) submitted on Nov. 20, 2017, an amendment to the 1115 demonstration waiver application originally sent to CMS in June 2016. The amended waiver submission is the next step in the transformation of North Carolina Medicaid and NC Health Choice programs to managed care, driving the State's goal to implement a health care system that improves health, value and access to care. DHHS worked with stakeholders and experts to refine program design and implementation approach, including seeking public feedback during dozens of listening sessions held across North Carolina.

NC Amended Section 1115 Demonstration Waiver Application - Nov. 20, 2017

Amended Section 1115 Waiver Application Fact Sheet - Nov. 21, 2017 

Concept Papers - 2017 & 2018

Over the next several months, DHHS will release a series of North Carolina Medicaid managed care program concept papers. The concept papers provide details on specific components of the proposed managed care program design. Each concept paper will be posted below as it is released. Comments are welcome and encouraged by sending an email to Medicaid.Transformation@dhhs.nc.gov by the date listed next to the concept paper.

Prepaid Health Plan Network Adequacy and Accessibility Standards - Released February 15, 2018. Comment period will end March 29, 2018.

Addressing Hospital Supplemental Payments in the Transition to Managed Care - Released Nov. 20, 2017. Comment period closed Dec. 20.

Behavioral Health and I/DD Tailored Plan Concept Paper - Released Nov. 9, 2017. Comment period closed Dec. 11.

Population Profiles - Released Nov. 9 as a companion document to the Behavioral Health I/DD Tailored Plan Concept Paper.

Medicaid Managed Care Requests for Information - November 2017

DHHS released two Requests for Information on Nov. 2, 2017. One RFI addressed managed care operations, including a statement of interest from prospective prepaid health plans (PHPs). The other RFI addressed the financial aspects of managed care, including information on the proposed capitation rate setting methodology. DHHS accepted RFI responses through Dec. 15, 2017.

Managed Care Program RFI - Actuarial (RFI 30-DHB-110217-18-A2); addendum revising response due date to Dec. 15, 2017
Managed Care Program RFI - Operations (RFI 30-DHB-110217-18-O); addendum revising response due date to Dec. 15, 2017

Note: The information submitted in response to the RFIs is being used to develop formal procurement solicitations (requests for proposals) and does not become public information until after the award of the contract. The Department cannot release copies of RFI responses until the solicitation process is completed and contracts awarded OR the need for a procurement no longer exists. Please refer to Section I.C.1 of RFI 30-DHB-110217-18-A2 and Section I.D.1 of RFI 30-DHB-110217-18-O for additional information.

RFI Respondents

Below are the respondents to the RFIs, which are published similar to bidder tabulations typically posted on the State's Interactive Purchasing System (IPS) for formal procurements.

RFI Responding Vendors - Actuarial - Dec. 15, 2017
RFI Responding Vendors - Operations - Dec. 15, 2017

Medicaid Managed Care Proposed Program Design - August 2017

DHHS released in August 2017 a detailed proposed program design for transforming the state Medicaid and NC Health Choice programs to managed care. This proposed design document ensured that providers had an opportunity to review and comment on the specifics of the DHHS vision for managed care.

Medicaid Managed Care Proposed Program Design - August 2017

Proposed Program Design Information for Beneficiaries and Providers

The documents below provide a brief look at the key points of the proposed program design and how it could affect a provider or beneficiary.

Medicaid Managed Care: A guide for people with North Carolina Medicaid - August 2017

Medicaid Managed Care: A guide for North Carolina Medicaid and NC Health Choice providers - August 2017

Medicaid Managed Care Public Input Summaries

DHHS knows it is crucial to listen to and learn from the people who live and work with Medicaid every day. To develop the strongest Medicaid program for North Carolina, DHHS continues to talk with providers, beneficiaries and advocates, health care experts across the state and the country, leaders in other states who have already transitioned Medicaid programs to managed care, and many others interested in improving the health of North Carolinians. DHHS is committed to continuing this partnership.

Proposed Program Design Public Comment Summary - August/September 2017

Medicaid Managed Care Public Comment Summary - April/May 2017

Your Comments are Always Welcome

Email
Medicaid.Transformation@dhhs.nc.gov

US Mail
Dept. of Health and Human Services, Division of Health Benefits
1950 Mail Service Center
Raleigh NC 27699-1950

Drop-off
Dept. of Health and Human Services, Dorothea Dix Campus
Adams Building Reception
101 Blair Drive
Raleigh NC