Provider Updates on Medicaid Transformation in North Carolina

North Carolina is changing the way Medicaid services are provided, from fee-for-service to managed care.  More than 1.6 million North Carolinians are scheduled to transition to the managed care model on July 1, 2021 with open enrollment beginning March 15, 2021. 

The North Carolina Department of Health and Human Services (NC DHHS) chose Blue Cross and Blue Shield of North Carolina (Blue Cross NC) as one of four statewide carriers called Pre-Paid Health Plans (PHPs). NC DHHS also chose one regional provider-led entity (PLE) to provide these services.  Blue Cross NC’s plan for Medicaid members is called Healthy Blue. 

Resources for Providers 

In addition to the NC Medicaid Provider webpage, Medicaid and NC Health Choice providers now have a supplemental resource to research their questions and submit inquiries. The NC Medicaid Help Center is an online source of information about Managed Care, COVID-19 and Medicaid and behavioral health services, and is also used to view answers to questions from the NC Medicaid Help Center mailbox, webinars and other sources. Formerly referenced as the “SWAT Command Center,” the NC Medicaid Help Center also includes resource documents such as standard and COVID-19 Medicaid Bulletins. 

• For more information about Medicaid Transformation, including how to become a Medicaid provider, see the Provider Playbook: Medicaid Managed Care page on the NC DHHS website. 
• For more information about Healthy Blue, including how to become a Healthy Blue provider, visit our Healthy Blue Provider Website.  

Training for in-network Healthy Blue providers is scheduled to begin in mid to late May. Stay tuned for more information. 

Open Enrollment for Medicaid Members 

During open enrollment from March 15 through May 14, 2021, Medicaid beneficiaries on the Standard Plans can choose a health plan. Beneficiaries are receiving enrollment packets from NC DHHS, showing them their choices.  Medicaid members on the Standard plans can enroll online, over the phone, by mail or by using the mobile app. 

• Online:  Go to www.ncmedicaidplans.gov to enroll online 
• Phone:  Call 833-870-5500 (TTY 833-870-5588), 7AM to 5PM, Monday through Saturday 
• Mail:  Fill out the enrollment form you receive in the mail 
• Mobile app: Get the free mobile app by searching for NC Medicaid Managed Care on Google Play or the App Store 

Medicaid fills the gaps in our health care system and serves some of the most vulnerable populations, including pregnant women and children. The transition to Medicaid managed care will give beneficiaries a choice in their health coverage and increase the focus on non-clinical drivers of health, sometimes called social determinants of health. 

We look forward to working with you to serve Healthy Blue members.