Medicaid Managed Care Proposed Concept Paper: North Carolina’s Vision for Long-term Services and Supports under Managed Care

North Carolina

~~“The first priority of the North Carolina Department of Health and Human Services (the Department) is the health and well-being of the beneficiaries it serves. Medicaid beneficiaries who use long-term services and supports (LTSS) are among North Carolina’s most vulnerable residents. The Department wants to ensure that this population experiences a seamless transition to Medicaid managed care and receives highquality, accessible services within managed care.

North Carolina is transitioning its Medicaid and NC Health Choice programs’ care delivery system for most beneficiaries and services from a predominantly fee-for-service1 to a predominantly managed care system.2 Because of this transition, newly procured prepaid health plans (PHPs) will provide LTSS to enrollees currently receiving such services through Medicaid. The populations using LTSS are extremely diverse in terms of individuals’ care needs, service utilization and spending. Managed care can offer significant opportunities to improve care coordination, access to community-based services and outcomes for these vulnerable populations, but requires special planning and preparation to ensure relationships with long-standing clinical and non-clinical providers will not be disrupted in the transition, that PHPs will be experienced in serving people with disabilities in a culturally competent manner, and that quality of care will be measured in a way that is meaningful to people who use LTSS.”

State Policies & Initiatives: 
Policy
Systems: 
  • Other
Topics: 
  • Data Sharing
Other: 
  • Department of Health and Human Services
Date Enacted: 
04/05/2018
CITATIONS: