NC Managed Medicaid Starts July 1, 2021

As you have likely heard, North Carolina Medicaid is shifting to Managed Medicaid starting July 1^, 2021, and, as your partner in mobility, National Seating & Mobility is here to ensure your patients continue to get the independence and support they deserve.

NSM has been communicating with Medicaid and the commercial carriers who will be managing the Medicaid coverage regularly so we can anticipate and have a plan to mitigate gaps of care and ensure timely provision of your patients’ mobility devices and adaptive aids.

What you should know about wheelchair and adaptive aids provision during this change:

NSM has your patients covered!  NSM is in network with all the health plans that will be managing North Carolina’s Medicaid program.

 Enrollment options:

Beneficiaries will have six health care options to choose from when they enroll, based on the region in which they live:

• WellCare
• UnitedHealthcare Community Plan
• Healthy Blue
• AmeriHealth Caritas
• Carolina Complete Health
• EBCI Tribal Option(PCP only)

Open enrollment was May 14^th- May 21^st to select a plan. If a plan was not selected, your patient will be auto enrolled into a plan based on available plan options in their county.

What to expect:

July 1, 2021 – Medicaid Managed Care launch

The MCO Health Plan’s must honor existing and active prior authorizations on file with the North Carolina Medicaid or NC Health Choice for the first ninety (90) days after implementation to ensure continuity of care for members.

Out of network providers will be treated as in network only during the first 60 days of the transition for any open orders and reimbursed as they were with NC Medicaid FFS, then clients will need to work with in network providers.

Who does not need to select an MCO plan?

Some people will not need to choose a health plan because of the type of health services they need. They will stay enrolled in NC Medicaid Direct. For example, individuals who get Innovations Waiver services, Traumatic Brain Injury (TBI) Waiver services, or Community Alternatives Program for Children (CAP/C) or Community Alternative Program for Disabled Adults (CAP/DA) services will stay enrolled in NC Medicaid Direct. If you qualify, you can choose the EBCI Tribal Option and keep getting waiver services.

Beneficiaries have 90 days after the effective date of initial enrollment to change their Health Plan or PCP for any reason.

Exempt populations:

Members of federally recognized tribes

Excluded populations:

• Beneficiaries dually eligible for Medicaid and Medicare
• Program of all-inclusive care for the elderly (PACE) beneficiaries
• Medically needy beneficiaries
• Beneficiaries eligible for only emergency services
• Presumptively eligible enrollees during the period of presumptive eligibility
• Health insurance premium payment (HIPP) beneficiaries
• Family planning beneficiaries
• Prison inmates