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Confused About Medicaid Transformation? Here's Some Help

National Cancer Institute

For the first time ever, most Medicaid patients have to choose their health plan. It’s part of North Carolina’s transition to managed care, and Charlotte’s Center for Legal Advocacy wants to make sure beneficiaries understand the changes.

“This is a completely new world for many Medicaid beneficiaries,” says attorney Rebecca Friedman with the Center for Legal Advocacy. Eligibility criteria won’t change, but Friedman says enrollees may need help to “understand what a plan network is, and what they’d have to do to ensure that they can still see their providers.”

There are 2.3 million Medicaid recipients in North Carolina, but only 1.6 million of them need to enroll in a plan. Friedman worries that some beneficiaries may be confused whether they’re one of the ones that has to sign up.

Some people — like those who receive both Medicaid and Medicare— won’t transition to managed care. Others people — including some receiving services for behavioral health needs — have the option of staying in their current plan.

Confused yet?

In March, the North Carolina Department of Health and Human Services sent out a letter to all Medicaid recipients telling them whether they must enroll. But Friedman is concerned the letters were confusing. She also worries some people may have moved during the coronavirus pandemic and didn’t receive the packet.

One key point: Enrollment ends May 14. Those who don’t choose a plan by then will be assigned to one.

Last month, North Carolina’s Department of Health and Human Services’ Dave Richards told WFAE that beneficiaries who are assigned to plans will be able to remain with their current doctor. And beneficiaries can change plans for 90 days after the new plans begin on July 1.

An explanation of the changes is available in English and Spanish at the Center for Legal Advocacy’s website. Enrollment information is also available at the North Carolina Department of Health and Human Services website for Medicaid Transformation or through enrollment brokers at 833-870-5500. Friedman says anyone with questions can also call her directly at 980-202-7349, and those who have questions or complaints can reach out to the Medicaid Ombudsman.

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Dana Miller Ervin is a reporter at WFAE, examining the U.S. health care system.