Prepaid Health Plan Contracts Selected for NC Medicaid Managed Care

The North Carolina Department of Health and Human Services (DHHS) announced the selection of Prepaid Health Plans (PHP) that will participate in Medicaid managed care when the program launches in November 2019.

Statewide PHP contracts were awarded to AmeriHealth Caritas North Carolina, Inc.; Blue Cross and Blue Shield of North Carolina; UnitedHealthcare of North Carolina, Inc.; and WellCare of North Carolina, Inc. A regional contract for Regions 3 and 5 was awarded to Carolina Complete Health, Inc.

A map of PHP regions can be found here.

In 2015, the General Assembly directed the transition of Medicaid to a managed care structure. Under the managed care model, DHHS will continue to oversee the Medicaid and NC Health Choice programs, but PHPs will directly manage certain health services, assume financial risk and contract with physicians and providers to deliver services for beneficiaries.

Medicaid managed care Standard Plans will launch in two phases. The first will launch in November 2019 for beneficiaries in the following 27 counties: Alamance, Alleghany, Ashe, Caswell, Chatham, Davidson, Davie, Durham, Forsyth, Franklin, Granville, Guilford, Johnston, Nash, Orange, Person, Randolph, Rockingham, Stokes, Surry, Vance, Wake, Warren, Watauga, Wilkes, Wilson and Yadkin. Standard Plans will launch in the remaining counties in February 2020.

A fact sheet with more information can be found here.