Aetna

shows a map of North Carolina broken up into six regions for Medicaid managed care provision

Medicaid managed-care wannabes take protest to new court

September 29, 2020 by Anne Blythe

Medicaid managed-care wannabes take protest to new court - North Carolina Health News

After losing out on lucrative contracts with DHHS, Medicaid managed care companies file appeals once again ahead of next year's start date.

By Anne Blythe and Rose Hoban In the middle of a coronavirus pandemic that has tossed up challenge after challenge, the state Department of Health and Human Services also must tend to another enormous project. Over the next 10 months, the department has been told by the legislature to complete the transformation of its cumbersome […]

shows a paper reading, "Insurance policy" with glasses and a pen in the foreground

Health insurance premium picture for coming year uncertain

July 28, 2020 by Rose Hoban

Health insurance premium picture for coming year uncertain - North Carolina Health News

COVID-19 continues to rage with no end in sight, even as deadlines for insurers to ask for next year’s premium rates arrive. How do insurance companies know what their rates should be?

By Rose Hoban Even as 2020 doles out one earth-shaking event after another, the insurance companies that can help soften the blows of coronavirus and other health care costs for their members still must try to predict premiums for the coming year. In these uncertain times, as cases of COVID-19 surge across the nation and […]

A graphic with money in the background. Medicaid transformation graphic, prepaid health plan, medicaid expansion

Wannabe Medicaid managed care groups still fighting for a slot

January 24, 2020 by Sarah Ovaska

Wannabe Medicaid managed care groups still fighting for a slot - North Carolina Health News

With claims of conflict of interest and bias, bypassed managed care groups have gone to court to ask for a second shot at getting N.C. Medicaid’s managed care contracts.

By Sarah Ovaska While a move to switch Medicaid to a managed care system in North Carolina is on indefinite hold, several companies rejected by state health officials for lucrative managed care contracts are still vying for seats at the table. If N.C. Administrative Law Judge Tenisha Jacobs agrees with lawyers in her Raleigh courtroom […]

shows image of Lady Justice from the Old Bailey in London, managed care

Some managed care groups want a piece of N.C.’s Medicaid pie, but judge says ‘No’

July 3, 2019 by Sarah Ovaska

Some managed care groups want a piece of N.C.’s Medicaid pie, but judge says ‘No’ - North Carolina Health News

Billions of dollars in Medicaid contracts are at stake for companies looking to become providers in the state’s transformed system.

By Sarah Ovaska-Few A North Carolina administrative law judge shot down requests last week from a trio of organizations that wanted to hit the pause button on the state’s ongoing transition of its Medicaid system to a managed care system. Judge Tenisha Jacobs recently ruled in favor of the N.C. Department of Health and Human […]

Would-be Medicaid managed care groups ask judge for second look

May 28, 2019 by Sarah Ovaska

Would-be Medicaid managed care groups ask judge for second look - North Carolina Health News

Ongoing court challenges to the DHHS' choices for Medicaid managed care providers threaten to derail the schedule for transitioning the program, set to start this November. More than $30 billion in contracts is at stake.

By Sarah Ovaska-Few North Carolina’s ongoing transition to Medicaid managed care system could screech to a temporary halt if an administrative law judge agrees with rejected managed care groups that the process to select contractors was flawed and unfair. Lawyers for three prepaid health care plans — Aetna Better Health, a commercial managed care company; […]

N.C.’s path to Medicaid managed care gets complicated

April 12, 2019 by Sarah Ovaska

N.C.’s path to Medicaid managed care gets complicated - North Carolina Health News

Before the new managed care regimen can go live state officials have to get through the legal appeals filed by companies not chosen to do the work.

By Sarah Ovaska-Few Shifting North Carolina’s massive Medicaid program to a managed care system was bound to get messy. And so, it has. The ambitious plan – to pay managed care companies $30 billion over five years to handle the health-care needs of 1.6 million low-income North Carolinians – is expected to go live in […]

Man stands at a podium, points at an easel with a display on it, explaining his Medicaid expansion plan

Lawmakers look for ways to cover more low-income uninsured

April 10, 2019 by Rose Hoban

Lawmakers look for ways to cover more low-income uninsured - North Carolina Health News

A group of Republicans in the state House of Representatives takes a gambit to get about a half million people access to care.

By Rose Hoban Two years ago, a group of Republicans in the North Carolina House of Representatives made a splash when they defied their party’s orthodoxy: They wanted to provide a way to get hundreds of thousands of low-income North Carolinians access to health insurance via the state’s Medicaid program. But they didn’t say they […]

An elderly man in his house's doorway holding a poinsettia, chatting with an elderly woman in a coat outside.

Friendship Trays fills a niche in Charlotte’s support system

January 11, 2019 by Yen Duong

Friendship Trays fills a niche in Charlotte’s support system - North Carolina Health News

Charlotte’s main Meals on Wheels program, Friendship Trays, brings nutritious meals to people who cannot prepare their own and serves as part of a social support network.

By Yen Duong Lucy Bush Carter remembers one man’s 98th birthday well. One of her volunteer drivers for Friendship Trays, Charlotte’s Meals on Wheels program, called her to say “I’m pretty sure he’s on the dining room floor,” Carter recalled. “By the time I got there, the firemen and all the first responders were standing […]

shows an old fashioned black telephone, sometimes scammers call on the phone

Hello? It’s I, Robot, And Have I Got An Insurance Plan For You!

November 7, 2018 by Kaiser Health News

Hello? It’s I, Robot, And Have I Got An Insurance Plan For You! - North Carolina Health News

Many people - too many - are getting multiple calls hawking health insurance and claiming they're offering ACA-compliant plans. But are they really?

By Barbara Feder Ostrov Kaiser Health News “Anna” will not stop calling. She really, really wants to sell you health insurance. What a lot of consumers really, really want is to smack Anna upside her robocalling head. As health insurance open-enrollment season gets underway in California and nationwide, automated phone calls offering Affordable Care Act […]

shows NC with the 100 counties divided by region into six regions for Medicaid bidders

Medicaid Managed Care: Who’s In the Running For Contracts With the State

October 23, 2018 by Sarah Ovaska

Medicaid Managed Care: Who’s In the Running For Contracts With the State - North Carolina Health News

North Carolina’s Medicaid plan is slated for big changes in the coming year, and companies are putting in bids to perform billions of dollars of work.

By Sarah Ovaska-Few A total of eight companies and provider-led groups are vying to manage the care of North Carolina’s Medicaid patients, contracts that could pay out as much as $30 billion over the next five years. The N.C. Department of Health and Human Services released a list of applicants this past week that included […]

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