NEWS: Two Bills Shape NC Medicaid

Posted:
Tags: News

Two bills passed in the recent legislative session that will shape NC’s Medicaid system for years to come.

Currently, North Carolina’s Medicaid program is mostly fee-for-service, with MH/DD/SAS services in managed care. The State is in the process of transitioning to a system that is predominately under managed care, with physical integrated with mental/behavioral health care. (Managed care means the Managed Care Organization in charge of providing services gets a fixed amount of each person it serves.)

House Bill 403, Medicaid and Behavioral Health Modifications, moves Medicaid patients with mild or moderate behavioral health needs to new Standard Plans. These consumers would be able to choose which company administers their healthcare services.

People with more intensive MH/DD/SAS/TBI-related needs would be under Tailored Plans. The existing LME/MCOs will administer these plans, and unlike the Standard Plans, consumers will have no choice regarding who administers their managed care plans. Disability Rights NC is actively engaged with the Department of Health and Human Services as it implements HB 403.

House Bill 156, Medicaid PHP Licensure & Transformation Modifications, requires Medicaid prepaid health plans (PHPs) to obtain a license from the Department of Insurance. Once LME/MCOs begin to offer the tailored plans authorized in HB 403, they will become PHPs and will also have Department of Insurance oversight. Gov. Cooper signed both bills into law on June 22.