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managed care

Image of money with a caduceus superimposed on the bills. We're using this image to denote Medicaid managed care.

Federal proposal could change the face of Medicaid in North Carolina

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Federal proposal could change the face of Medicaid in North Carolina - North Carolina Health News

A Trump Administration announcement of lump-sum offer for adult Medicaid coverage draws fire from some quarters.

By Sarah Ovaska and Liora Engel-Smith The Trump Administration announced a proposal Thursday that could potentially transform how Medicaid functions in some areas. The proposal would let states opt into a lump-sum funding system to pay for the health care needs of low-income, working-age adults. The proposal is already drawing fire from critics and Democrats […]

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

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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 […]

Two women take a selfie at a conference where they talked about medicaid transformation

With Medicaid transformation stuck mid-stream, DHHS seeks to reassure patients, providers

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With Medicaid transformation stuck mid-stream, DHHS seeks to reassure patients, providers - North Carolina Health News

At a conference this week to discuss upcoming changes to Medicaid, DHHS officials sought to reassure people that the transformation will happen, they're just not sure when.

By Rose Hoban All dressed up and ready to … wait? That was the prevailing sentiment in Pinehurst this week at the annual Center for Integrative Health conference designed to help Medicaid providers, contractors and patients share best practices. Even though the Pinehurst resort was decked out in holiday finery, many of the folks who […]

shows a red cross with the word Medicaid printed on it, in front of a pile of dollar bills. For Medicaid transformation

NC’s Medicaid transformation suspended indefinitely

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NC’s Medicaid transformation suspended indefinitely - North Carolina Health News

With North Carolina Republican legislators and Gov. Roy Cooper at a budget impasse, North Carolina’s secretary of health suspends a long awaited move to Medicaid managed care.

By North Carolina Health News staff What state health officials have hinted at for weeks happened officially on Tuesday. The state Department of Health and Human Services announced that the long-awaited transformation of Medicaid to managed care from the existing fee-for-service system will not go live on Feb. 1 as planned. Nonetheless, Medicaid beneficiaries should […]

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

No state budget, no Medicaid transformation? 

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No state budget, no Medicaid transformation?  - North Carolina Health News

The impasse in Raleigh may (again) push back what’s slated to be the biggest change to North Carolina’s health networks in decades. 

By Sarah Ovaska-Few Talk about a health care policy cliffhanger. On one hand, North Carolina is slated to drastically alter the health care landscape of the state with a scheduled February handoff for most of its massive Medicaid system to managed care companies. The hope is that these companies, which will be paid a capitated, […]

Image of money with a caduceus superimposed on the bills. We're using this image to denote Medicaid managed care.

Budget impasse delays Initial Nov. 1 rollout of Medicaid managed care

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Budget impasse delays Initial Nov. 1 rollout of Medicaid managed care - North Carolina Health News

Instead of one quarter of the state program going live this fall, the entire state will make the transition to managed care in Feb. 2020

By Sarah Ovaska-Few and Rose Hoban The standoff between North Carolina’s state government power brokers over the state budget and Medicaid expansion has claimed a victim: the planned roll-out this fall of Medicaid managed care. N.C. Department of Health and Human Services Sec. Mandy Cohen announced Tuesday morning she was pushing back the Nov. 1 […]

a man at a podium tries to avoid talking about Medicaid expansion

NC health department would face ‘dramatic’ cuts under proposed budget

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NC health department would face ‘dramatic’ cuts under proposed budget - North Carolina Health News

Sec. Mandy Cohen spent big portions of her week walking the halls of the legislature, to push back against cuts to DHHS.

By Taylor Knopf and Rose Hoban As the state budget moves toward what looks to be an inevitable veto from Gov. Roy Cooper, state health leaders are raising alarm about some of the budget provisions drafted by Republican state lawmakers. Health and Human Services Sec. Mandy Cohen argues that some of the deep cuts could […]

shows a map of North Carolina broken up into six regions

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

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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; […]

shows a map of North Carolina broken up into six regions

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

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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 […]

shows a map of North Carolina broken up into six regions

Medicaid changes will become more visible to beneficiaries, providers

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Medicaid changes will become more visible to beneficiaries, providers - North Carolina Health News

Now that the providers for a privatized Medicaid managed care system have been chosen, HHS Sec. Mandy Cohen says beneficiaries will soon need to choose their providers.

By Rose Hoban Most of North Carolina’s 2.1 million Medicaid recipients are likely unaware  that the program is about to dramatically change. That’s because, for years, most of the activity to make the transformation has taken place in legislative hearings and departmental conference calls. But no longer. After years of planning, the changes to North […]