Stakeholder Communication Key for Shift to Medicaid Managed Care

October 23, 2019 - North Carolina’s transition from a fee-for-service (FFS) model to Medicaid managed care has faced some challenges, but keeping open communication lines with stakeholders enables the state’s health department to move forward.

Since the managed care waiver earned CMS approval in 2018, provider contracting was slow and there were outages with the enrollment broker website and call center.

But those were smaller concerns next to the major challenges of an uncertain state budget and legal issues with payer, Aetna, which claims the contract awarding process was tainted by favoritism toward Blue Cross North Carolina.

North Carolina’s general assembly has been working toward a consensus on the 2020 state budget, The Laurinburg Exchange recounted. The Republican assembly put together a mini-budget which the governor vetoed. As a result, the Medicaid managed care programs in two regions, which were scheduled to go live in November, have been postponed to rollout in February with the rest of the state.

With the particular challenges of its rollout process, the North Carolina Medicaid program has learned three main lessons.

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Communication with payers and enabling productive contract conversations with providers is key, Dave Richard, deputy secretary of the North Carolina Medicaid program, explained to HealthPayerIntelligence.com.

As the timeline winds down to their November 15 provider enrollment deadline, the department has been communicating with health payers to pinpoint any challenges that are slowing down contracting. Negotiating provider rates has been a common theme.

“We of course, as the state agency, do not want to be in the middle of negotiations between providers and health plans. But we want to make sure that all the tools that are available, that they understand, and that we're, again, facilitating the conversations the best we can,” said Richard.

In addition to communicating with payers, engaging the provider community early on and regularly throughout the Medicaid managed care rollout is key, Richard shared. It is imperative that programs make timelines and the urgency of those deadlines clear.

To get auto assignment ready for beneficiaries, the department has been working with primary care providers to get them enrolled by November 15. Primary care physicians represent a critical element of the auto assignment algorithm as the state tries to ensure that beneficiaries stay with their primary care provider. But while independent providers have been quick to sign up, providers who are a part of a health system have been slower in doing so.

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Lastly, being close and transparent with the state legislature has been of particular importance to North Carolina’s Medicaid program but, Richard believes, is something that any state needs to keep in mind.

Richard recognized the concerns this could cause for beneficiaries, especially those who have already had their go-live date pushed back. While the budget is out of the department’s hands, Richard indicated that the department is concentrating on communicating with beneficiaries.

“The most important thing is to have that communication with all of the stakeholders,” the North Carolina Medicaid program deputy secretary summarized.

In the midst of a tumultuous start to their Medicaid managed care program, North Carolina’s Department of Health and Human Services also faces a lawsuit from health payer Aetna.

Aetna alleges that the state’s Department of Health and Human Services was biased in its decision due to personal relationships between Blue Cross North Carolina representatives and state board members.

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Aetna has been embroiled in similar litigation against Louisiana’s Medicaid managed care contract since August.

“The legal process will take its course and whatever happens there, we'll adjust to that,” Richard said. “For our staff, the message that we're giving everyone is that we will go live and let us keep working toward that goal and everything else will take care of itself outside of that.”

As the health department moves forward, the future is uncertain. It relies heavily on the general assembly’s progress with the budget.

“If we don't have a budget by mid-November this year, then we are in a position where we can't go live in February,” Richard said.

Despite these obstacles, Richard remains optimistic.

“I think generally things are going as well as can be expected with such a big transition in North Carolina,” Richard affirmed, referring to the state’s transition to Medicaid managed care.

Open enrollment for North Carolina’s Medicaid managed care began Thursday, October 17 and will remain open until February.