Statement from NCDHHS on Medicaid Managed Care Ruling

Raleigh, N.C.

The NC Department of Health and Human Services (NCDHHS) is pleased to announce that once again court rulings affirm the integrity and fairness of the Departments’ managed care procurement process. On August 25, 2020, Administrative Law Judge Jacobs notified the parties that she granted the Department’s request for summary judgement. This means that all claims against the Department by petitioners Aetna, Optima and My Health by Health Providers are resolved in favor of the Department. This is the second time that Judge Jacobs has ruled for the Department and against entities that were not selected to participate as managed care health plans. On June 26, 2019, Judge Jacobs denied a request to halt the implementation of transformation, finding that none of the petitioners were likely to succeed on the merits of their claims. As directed by the NC General Assembly, NCDHHS is transitioning Medicaid and NC Health Choice to managed care and is set to go live on July 1, 2021.

North Carolina’s approach to managed care has received national recognition and focuses on improving the health of North Carolinians through an innovative, whole-person centered and well-coordinated system of care that addresses both the medical and non-medical drivers of health.

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