On Friday, Aug 28, the NC Department of Health and Human Services (NCDHHS) announced that “once again court rulings affirm the integrity and fairness of the Departments’ managed care procurement process.”

This week a judge dismissed claims that were made by a group of bidders who lost in their effort to secure some of the state’s managed care business. The collective of losing bidders argued that Blue Cross Blue Shield of North Carolina got the business through an improper bid process.  

When North Carolina’s Medicaid program transitions to a managed care format in 2021, that contract will mean billions of dollars of business for Blue Cross.

As directed by the NC General Assembly, NCDHHS is transitioning Medicaid and NC Health Choice to managed care and is set to go live July 1, 2021.

On Tuesday, Aug. 25, Administrative Law Judge Tenisha Jacobs notified the parties involved that she was granting the NCDHHS’s request for summary judgment – which meant that all claims against the Department by petitioners Aetna, Optima and My Health by Health Providers were resolved in favor of NCDHHS.

This is the second time that the same judge has ruled in favor of the state’s health and human services department and against the health administrative companies that weren’t selected to take part in the state’s plans to manage health care services.

In late June of last year, Judge Jacobs denied a request to halt the implementation of transformation after she found that “none of the petitioners were likely to succeed on the merits of their claims.”

A press release from NCDHHS announcing the victory stated that North Carolina’s approach to managed care “has received national recognition and focuses on improving the health of North Carolinians through an innovative, whole-person centered and well-coordinated system of care that addresses both the medical and non-medical drivers of health.”

 

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