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The other prepaid health plans are AmeriHealth Caritas of North Carolina, UnitedHealthcare of North Carolina, WellCare of North Carolina, and Carolina Complete Health, Inc., according to the state’s Medicaid site. The contract also includes a case management organization, the Eastern Band of Cherokee Indians (EBCI) Tribal Option.
“Medicaid transformation gives more than 1.6 million North Carolinians the ability to choose a health plan, but it’s more than that. It increases resources to address drivers of health, such as food security and transportation, that impact health outcomes,” Fran Gary, senior vice president of government markets at Blue Cross NC, said in the press release.
“Blue Cross NC has designed Healthy Blue to help our Medicaid members get access to the health services and community resources they need to improve their health.”
Each month, the state will reimburse health plans for a predetermined amount to cover the care needs of each Medicaid beneficiary. By operating through a private health plan, beneficiaries may have access to more preventive health, care coordination, and behavioral healthcare support.
The program's managed care contract is a value-based contract so the health plans will receive rewards for positive patient outcomes.
Apart from traditional requirements, Medicaid managed care organizations can also cover transportation services, offer rewards for provider visits, and reimburse for fresh vegetables and fruits for three months up to $120.
Tangential to this and other initiatives, Blue Cross of NC also invested in social determinants of health assistance such as the American Heart Association’s mobile kitchen and the North Carolina Coalition to End Homelessness.
“The start of Healthy Blue enrollment is part of a significant milestone for North Carolina as the state’s Medicaid program transitions to managed care,” the press release explained.
North Carolina’s Medicaid transformation has been contentious. The state’s legislature has repeatedly rejected Medicaid expansion proposals.
When the state’s General Assembly failed to pass a budget in its 2019 session, it further delayed changes to the Medicaid program.
At last, in July 2020, the North Carolina legislature settled on expanding Medicaid access by transitioning its Medicaid program from a fee-for-service reimbursement model to a managed care approach. Policymakers gave the Medicaid program one year to contract with managed care organizations and change its approach.
Medicaid program leaders admitted that the deadline seemed tight, but expressed confidence that the goal was achievable barring certain challenges.
However, the transition has not been seamless and Blue Cross NC was at the center of the controversy.
Aetna Better Health of North Carolina, Optima Family Care of North Carolina, and My Health by Health Providers challenged the results of the contract bid, specifically the state’s selection of Blue Cross NC. The rejected payers claimed that there were improprieties in the process given relational and professional connections between the health department and the payer.
Ultimately, however, the case was dismissed in August 2020.
Then, in February 2021, an audit of the North Carolina Medicaid program revealed millions of dollars of improper Medicaid payments.
However, policymakers may hope that the transition to a managed care model may help prevent a recurrence of this issue.
“The changes are designed to create a system of better-coordinated, high-quality care for Medicaid beneficiaries, while also offering additional community resources and bringing Medicaid budget predictability to the state,” the press release explained.
