By Liora Engel-Smith
As the July 1 rollout date for North Carolina’s transition to managed care fast approaches, a coalition of advocacy groups, insurers and other community organizations says a substantial chunk of enrollees do not know enough about the change.
The so-called transformation will change Medicaid, the largest public insurer in the state, into something that looks and acts more like private health insurance.
Roughly two-thirds of the safety net program’s enrollees — currently some 2.5 million people — will get their care from one of five commercial plans managed by private insurance companies (a sixth plan will be run by the Eastern Band of the Cherokee for tribal members). The first phase of that transition process, the open enrollment period, ended last month.
North Carolina for Better Medicaid, a group that includes insurers Blue Cross and United, which captured nearly 700,000 Medicaid enrollees between them, conducted an internet survey of 1,000 North Carolinians, including 100 Medicaid enrollees. Current enrollees, the survey found, knew more about the impending transition compared with the general population. But a little over a quarter of participants who had Medicaid said they didn’t know about the transition, despite widespread outreach efforts from the state and insurers themselves.
Jereen Wells, a hairstylist in rural Wayne County and a Medicaid enrollee, said the selection process, which involved choosing a provider for herself and her children, was stressful and confusing.
“I’m just rolling with the punches right now,” she said in an email. “I’m kind of embarrassed to say that but it’s just that.”
Wells isn’t the only one. Data from the state shows that only about 15 percent of enrollees chose a plan for themselves. That number is on par with the state’s estimate and similar trends in other states that moved their Medicaid programs to managed care.
Got questions about Medicaid managed care? We’ve got answers.
Speaking about the transition in a press conference earlier this month, NCDHHS Secretary Mandy Cohen stressed that the state is working to ensure a smooth transition for enrollees and will allow participants flexibility to change their plan assignment for any reason in the first 90 days. The state also designated an ombudsman to educate and assist enrollees.
“With any major, major transition like this of course there are always things in questions we need to answer,” she added, “So just know that we are ready to do that and want to make sure that everyone gets their questions answered and that patients are seen on July 1 just like they would get seen on June 30.”
NC Medicaid Ombudsman: For questions or concerns regarding Medicaid managed plans, enrollees can visit https://ncmedicaidombudsman.org/ or call 877-201-3750
Significant change amid a pandemic
The largest change in North Carolina’s Medicaid program history, the transition to managed care comes after a five-year push to reconfigure the $14 billion program. The state will pay the five insurers a flat monthly fee per enrollee. Insurers will then use that sum to provide care that promotes good health outcomes. This so-called value-based care model means that rather than paying for each test or prescription, the state health department will pay insurers based on health outcomes, such as controlling a patient’s cholesterol or lowering their high blood pressure.
But the transition was overshadowed by an unprecedented pandemic that upended many aspects of daily life. Even with the return to a semblance of normalcy, other state efforts, including a chance to win a cash prize for getting vaccinated, have drawn more attention.
Representatives from the North Carolina for Better Medicaid coalition said their survey — though limited to self-reported answers from people with adequate broadband access — puts the transformation front and center ahead of the July 1 move.
“The North Carolina Coalition for Better Medicaid noticed that there wasn’t much data or for that matter folks talking about Medicaid transformation, said Spokeswoman Alexanda Sopko said earlier this week. “And so that was the reason to get that baseline.”
The change comes with programs that promote well-being, including projects that will focus on tackling the social and environmental factors that affect enrollees’ health. For instance, insurers will provide rides to participants who can’t otherwise make it to the doctor. Some plans will also include education programs on diabetes management, exercise and wellness, and more.
The state’s 100-plus YMCAs will help with these initiatives, said Sherée Vodicka, CEO of the NC Alliance of YMCAs. The pandemic and the difficulty of reaching some enrollees even without a global health crisis has meant that everyone — from health care providers to community organizations — has to get involved.
The message about managed care has to “go out in so many different ways” to get to as many enrollees as possible, Vodicka said.
“So the more partners getting the word out, the better. There may be somebody who just needs to hear it from the Y before they believe it, or there may be somebody who needs to hear it from their church and there might be somebody who is fine with reading it in the newspaper.”
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