Senate Bill 808 – Medicaid Funding Act

Cardinal Innovations Healthcare — julio 02, 2020
Senate Bill 808, the Medicaid Funding Act, was signed into law on July 2 by Governor Cooper after passing both the House and the Senate. This bill, among other things, forces North Carolina to resume the transition to Medicaid Managed Care.

Currently, North Carolina’s Medicaid program primarily operates using a fee-for-service model where providers receive payment for each service performed. The switch to a managed care model, a key aspect of Medicaid Transformation, will combine physical, behavioral, and pharmaceutical services into one integrated health plan managed by an insurer. Behavioral health benefits under NC Medicaid are already managed by LME/MCOs, and the scope of benefits managed by these entities will only increase once they transition to integrated care plans.

Various health plans will be available for Medicaid recipients to choose between, allowing families and individuals to pick the plan that best suits their needs. The health plans will be grouped into what have been deemed Standard Plans and Tailored Plans. Standard Plans are designed for the general Medicaid population, whereas Tailored Plans are designed for high-need recipients that require specialty care. 

Senate Bill 808 has set the first phase of Medicaid Transformation to go-live on July 1, 2021. On this date, Standard Plans will go-live. Tailored Plans won’t go-live until a year after. This is a large development after the North Carolina Department of Health and Human Services previously had to postpone this transition. It is the intention and hope of the state that managed care will increase access to Medicaid services and improve the system overall. 

Learn more about Medicaid Transformation here

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