RALEIGH — The state’s long-planned shift to Medicaid managed care took a major step forward Friday. The N.C. Department of Health and Human Services announced a contract with a global company to help participants in the government insurance program choose health-care plans.
DHHS will pay an estimated $17 million to MAXIMUS, a government services provider based in Reston, Virginia. The cost will depend on how many Medicaid recipients are eligible for managed care and whether DHHS adds optional services under the contract.
“Selecting an enrollment broker is an important milestone as we build a new system of managed care, and move toward our vision of an N.C. Medicaid program that optimizes health and well-being for all,” DHHS Secretary Mandy Cohen said in a news release.
About 2 million poor, aged, and disabled state residents receive Medicaid. The program spends about $3.7 billion in state funds, roughly 70 percent of the DHHS budget. The state is shifting away from an expensive fee-for-service model in which medical providers were paid for every clinical visit and procedure.
The transformation to managed care pays a set monthly amount and emphasizes quality of care and healthy outcomes instead of the number of procedures and treatments given. It is expected to launch in 2019 and would integrate physical and behavioral health care.
The state submitted a required waiver from its previous Medicaid program to the federal Centers for Medicare and Medicaid Services to create the managed care system. DHHS spokesman Cobey Colton said the waiver is in the final phases of review.
House Bill 372, the Medicaid Transformation and Reorganization act, passed in 2015, after the program piled up nearly $2 billion in shortfalls over four years. The first details of the plan were released in August 2017.
Under the managed care system, the state would create three statewide Prepaid Health Plans — networks of all essential health-care providers who would deliver all covered services. Large insurance companies are expected to bid for those contracts. The plan calls for up to 12 regional PHPs, which could be hospital-led or operated by physician groups.
For information on the department’s Medicaid transformation effort, visit https://www.ncdhhs.gov/medicaid-transformation.
MAXIMUS would give beneficiaries advice and help them choose among and enroll in health plans offered by the PHPs, a news release says.
MAXIMUS would help members select the best health plan and primary care provider for each patient’s needs. It would work to keep existing physician-patient relationships. MAXIMUS staff would help members enroll through a call center, a website, and — in some communities — in person, DHHS said.
The company would establish partnerships with the state’s 100 county departments of social services and provide liaisons to work with caseworkers and other county staff to provide managed care training, make materials available locally, and contact potential beneficiaries, DHHS said.
The department sought proposals in early March, and after reviewing the applications, picked MAXIMUS. The company announced July 24 it had signed an $11.7 million, four-year contract with an optional three-year extension to provide Medicaid enrollment services in Wisconsin
Dan Way is a staff writer for Carolina Journal.