On Tuesday, Sept. 3, the NC Department of Health and Human Services announced that it will extend open enrollment for Medicaid beneficiaries in Guilford County and 26 other counties and move to a statewide transition to managed care on February 1, 2020.
Previously, managed care across the state was scheduled to roll out in two phases, with Medicaid beneficiaries in part of the state beginning managed care services on Nov. 1, 2019 and most of the state beginning on Feb. 1, 2020. But, according to the press release sent out by the department, managed care will instead now go-live in one phase for the whole state beginning on Feb.1, 2020.
According to the department, the lack of a state budget was the primary reason.
“The timeline has been adjusted because DHHS cannot implement critical actions to go-live with managed care under the current continuing resolution budget,” the press release stated. “The updated timeline only impacts counties that were in Phase 1; it does not impact counties that were scheduled for Phase 2. The date of Feb. 1, 2020 for statewide implementation remains unchanged.”
The release also cites the complexity of the major move, citing the transition to managed care as “the most significant change ever undertaken by NC Medicaid.”
According to the department, the next set of steps that have to be taken depend upon budget action by state legislators, including things like finalizing the rates to pay health plans and providers, ensuring that health plans have enough providers in their networks to meet the needs of beneficiaries and “deploying a complex algorithm to assign beneficiaries who do not self-select plans and doctors and obtaining federal approval to launch.”
Since July, state Health & Human Service officials have told the department’s partners, as well as the North Carolina General Assembly, that the timing of the budget would impact the state’s schedule for moving to managed care.
Also, the budget stall has been an impediment to health plan providers finalizing contracts with doctors and health providers across North Carolina.
“The department remains committed to transitioning Medicaid and NC Health Choice from fee-for-service to managed care as directed by the NC General Assembly,” the department stated in the release. “DHHS will continue to move forward with activities that are not tied to budget action, including supporting open enrollment.”
It’s not just the budget veto that caused the delay in Medicaid transition. One of the mini-budget bills passed by the legislature provided the funding for Medicaid transition which is the result of a bipartisan effort to get costs under control. Republican legislators were baffled by Gov. Roy Coopers veto of this bill, since it was one that was the result of a bipartisan effort and had bipartisan support. Cooper said that passing the budget piecemeal was not the way to go, but he signed three of the four mini-budget bills, but vetoed this one.
The 27 counties where open enrollment will be extended are Alamance, Alleghany, Ashe, Caswell, Chatham, Durham, Davidson, Davie, Forsyth, Franklin, Granville, Guilford, Johnston, Nash, Orange, Person, Randolph, Rockingham, Stokes, Surry, Vance, Wake, Warren, Watauga, Wilkes, Wilson and Yadkin counties.