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Further Delays Hit the Implementation of Medicaid Managed Care Plans for Residents with Disabilities in North Carolina

Continuing Setbacks for the Launch of "Tailored Plans"

July 22, 2023North Carolina’s Department of Health and Human Services (DHHS) announced the third consecutive delay in implementing Medicaid managed care health plans specifically designed for individuals with behavioral or developmental disabilities.

These specialized health plans, termed as “tailored plans” by the state, have experienced postponements since the previous year. Initially scheduled to commence in the winter, DHHS pushed the kickoff date to October 1. The recent announcement did not disclose a new date for implementation.

The state created these tailored plans for Medicaid users with disabilities to resemble the general Medicaid managed care plans, which were successfully launched for the wider populace in July 2021. Regional mental health offices, designated as Local Management Entities/Managed Care Organizations (LME/MCOs), were to oversee these care networks. The LME/MCOs utilize state, federal, and local funds to render services for individuals with behavioral, intellectual, or developmental disabilities.

In the absence of these specialized plans, Medicaid beneficiaries with disabilities will continue utilizing fee-for-service care. According to DHHS, the proposed tailored plans were expected to cover around 160,000 individuals.

However, the enrollment process hit a snag as prominent hospital groups showed reluctance to sign network contracts, as stated in a report by NC Newsline in February.

During a legislative committee gathering in March, LME administrators mentioned facing difficulties in persuading Atrium Health, a major healthcare provider in Mecklenburg and Forsyth counties, to sign the necessary contracts. DHHS cautioned legislators in March that insufficient care networks would force numerous patients to seek new healthcare providers, potentially necessitating a journey of more than 30 miles to reach a primary care physician.

In an email statement, Atrium Health expressed its intention to sign the contracts eventually. The email read, “Our intent is to be contracted with each of the payors in this space to support this vulnerable patient population and its growing needs,” the Atrium Health email said.  “As the state has noted publicly, there are gaps in the technological capabilities and operational readiness of the tailored plans. We look forward to being able to move forward when the department and the plans have resolved these issues.”

In their press release, DHHS cited gaps in the provider network and the lack of a newly approved state budget as reasons for the latest delay. The state budget, which includes Medicaid funds, has been in limbo as legislators failed to pass a new budget by July 1, the start of the fiscal year.

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