TITLE
title
MEDICAID MANAGED CARE CONTRACTS WITH AMERIHEALTH CARITAS NORTH CAROLINA, INC. AND BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA
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SPONSOR
sponsor
Merle Green
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BACKGROUND
background
In 2015 the North Carolina General Assembly enacted House Bill 372, which transitions the NC Medicaid and Health Choice programs into a managed care model that relies on multiple statewide and regional prepaid health plans (PHPs) to manage the insurance risk of the program. Under managed care, these PHPs will contract with care providers to deliver services to their members. Statewide PHP contracts were awarded to the following entities, which will offer standard plans in all regions in North Carolina:
- AmeriHealth Caritas North Carolina, Inc.
- Blue Cross and Blue Shield of North Carolina
- United Healthcare of North Carolina, Inc.
- Wellcare of North Carolina, Inc.
Medicaid and NC Health Choice beneficiaries will enroll in a standard plan, which will cover integrated physical health, behavioral health and pharmeceutical services. To ease the transition to managed care, standard plans will be launched in two (2) phases, November 2019 and February 2020. Guilford County will be included in the initial launch of managed care beginning November 2019 and our DHHS - Public Health Division will serve as care provider for over 900 Medicaid and NC Health Choice beneficiaries. In preparation for the launch of managed care, contracts with two (2) PHPs, AmeriHealth Caritas North Carolina, Inc. and Blue Cross and Blue Shield of North Carolina, are offered for Board review and approval, to ensure provision of medical services for Medicaid and NC Health Choice recipients served by Guilford County Public Health. The contracts are effective November 1, 2019 through October 31, 2020.
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BUDGET IMPACT
budget impact
NO ADDITIONAL COUNTY FUNDS REQUIRED
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REQUESTED ACTION
requested action
Approve proposed contracts, in substantial form, with AmeriHealth Caritas North Carolina, Inc. and Blue Cross and Blue Shield of North Carolina for direct management of certain health services and financial insurance risks associated with the Medicaid Managed Care program, beginning November 1, 2019 through October 31, 2020.
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