DHHS Releases Request for Information for Medicaid Managed Care Program


The N.C. Department of Health and Human Services today asked health care providers, health plans and other stakeholders to provide information that will help the department transform the state Medicaid and NC Health Choice programs to managed care, as directed by the General Assembly in 2015.

DHHS released two Requests for Information, one addressing managed care operations, including a statement of interest from prospective prepaid health plans (PHPs), and one addressing the financial aspects of managed care, including information on the proposed capitation rate setting methodology. DHHS will accept responses to the Managed Care Request for Information until 2 p.m. on Nov. 22 and will accept responses to the Statement of Interest and Financial Request for Information until 2 p.m. on Dec. 1.

“This RFI is an important step toward implementing the proposed program design that DHHS released in August,” said DHHS Assistant Secretary for Medicaid Transformation Jay Ludlam. “We look forward to continued input and collaboration from health care providers, health plans and other stakeholders as we build the strongest possible Medicaid program for North Carolina.”

Medicaid managed care will be a significant change for the North Carolina Medicaid system. DHHS is releasing this RFI as part of its commitment to transparency and stakeholder engagement through the transformation of the Medicaid program.

“Our top priority is the health and well-being of the beneficiaries we serve,” said DHHS Secretary Mandy Cohen, M.D. “We want to do everything we can to build an innovative and whole-person centered system of care that focuses on both medical and non-drivers of health.”

In September 2015, the General Assembly directed the transition of Medicaid from a fee-for-service structure to a managed care structure. As DHHS prepares the transition, it will work with stakeholders and experts to refine program design and implementation approach. DHHS is using the RFI to solicit feedback from potential Medicaid managed care plans and other interested stakeholders on options and considerations related to Medicaid managed care design and implementation.

DHHS will use input on the Medicaid managed care RFI to inform a Request for Proposal (RFP) from entities that wish to participate as Prepaid Health Plans, which is expected to be released in Spring 2018.

The department's proposed program design seeks to use Medicaid managed care to advance high-value care, improve population health, engage and support providers and establish a sustainable program with predictable costs.

For additional information about transformation efforts, visit https://www.ncdhhs.gov/nc-medicaid-transformation.

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