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Medicaid Transformation & You: What You Need to Know

Medicaid Transformation: What is it and how will it work for clients?

Most people will get the same Medicaid services in a new way – through health plans. Instead of one Medicaid program there will be many health plans to choose from. Medicaid Managed Care will coordinate these health plans. These health plans work with different groups of doctors and health care professionals to give clients the health care that focuses on wellbeing and the prevention of chronic illness. NC Medicaid Managed Care will help clients get the most out of their Medicaid benefits.

Buncombe County Health and Human Services (BCHHS) will continue to assist clients with determining their Medicaid eligibility. The eligibility rules are not changing and clients should not lose any services. If the public wants to apply or recertify for Medicaid benefits, BCHHS is here to help!

In fact, all health plans are required to have the same Medicaid services, such as office visits, blood tests and X-rays. Health plans may also offer added services such as smoking cessation classes, nutrition education and assistance, and preconception and inter-conception health education.

Many people will not be affected by the change for quite a while. Those who are impacted in the upcoming transition will be receiving a welcome packet from Medicaid Managed Care. The packet will describe the transition and different health plan options.

Come Out & Learn More:
Enrollment for the new health plans will run through Oct. 14, 2019 until Dec. 13, 2019. Buncombe County HHS will be hosting Medicaid Health Plan Information Sessions in late October through November. We invite individuals who have general questions, community partners, and family members to come by to learn more about the new health plans. These sessions will provide an opportunity to meet face to face with an enrollment broker (who can help connect you to a health plan) and representatives from the various health plans.

The next Medicaid Health Plan Information Session will be on October 30, 2019 from 5-7 pm at 40 Coxe Avenue. If you park in Sears Alley Parking Garage, be sure to bring your parking garage ticket in with you for free parking during your visit. We invite individuals who have questions, people who have received their paper work in the mail, community partners, and family members to come by and learn more.

How to Choose a Health Plan and Medical Provider:
Most people receiving Medicaid must choose a health plan. Everything will come from the same plan including physical health, mental health, and medicine. 

Clients will also choose a primary care provider (PCP). A PCP is your family doctor, clinic or health care provider. If a person or family would like to keep the same doctor, clinic or other provider, they will need to contact that provider to find out which plans they work with.

Your PCP will help you with your health care needs. They will also coordinate your care with other health providers.

A small number of people will not need to choose a health plan because of the type of health services they need. They will stay enrolled in NC Medicaid Direct. NC Medicaid Direct provides services that meet specific needs such as services currently covered for developmental disability, mental illness, traumatic brain injury and substance use disorder. To learn more about NC Medicaid Direct, call 1-888-245-0179. It is possible to stay in NC Medicaid Direct, including your Local Management Entity-Managed Care Organization (LME-MCO). 

All health plans offer the same basic benefits and services.

To learn about the basic benefits and services that all health plans offer, and services that are not covered, go to Benefits and Services. Some services may only be available with prior authorization (pre-approval) or if medically necessary. For questions about benefits and services, contact the health plan. For health plan contact information, go to Contacts and Links. If you have questions, call the enrollment broker at 1-833-870-5500 (TTY: 1-833-870-5588). The call is free.

There are many ways to apply for Medicaid:

Terms to know:

Behavioral health provider: Professionals who diagnose mental health, substance use and intellectual and developmental disabilities conditions and provide treatment.
Health plan: A group of doctors, hospitals and other health care professionals. They work together to give you the health care you need. To learn more, go to Get Answers.
Network: A group of doctors, hospitals and other health care providers who contract with a health plan to give members medical care.
Primary care provider (PCP): Your PCP is your family doctor, clinic or other health care provider. Your PCP will help you with your health care needs. They will also coordinate your care with other health providers.

The attached document provides more information and links. 

Table: News Item Documents
File NameSizeTypeDate & Time Added
Medicaid Transformation Overview 649 KB 10/15/2019 5:13 PM