Macon County residents will start seeing major changes to the way they receive Medicaid later this year.
Due to legislation that was passed by the General Assembly in 2015, Medicaid will no longer work through a fee-for-service distribution model. Instead, it will run through a managed care model, which means that the state will contract with private companies and pay them a set rate for each person that they serve in the program.
Enrollment brokers will be available to help participants choose a plan that will allow them to keep their current doctors and plans through AmeriHealth Caritas North Carolina, Blue Cross and Blue Shield of North Carolina, United Healthcare of North Carolina and WellCare of North Carolina.
“The goal of the enrollment broker is to simplify the process and make it easier to understand,” said Eric Rubin, division president of health services for brokering firm Maximus. “The state and the local DSS will continue to determine eligibility, and that’s important for people to understand.”
Patrick Betancourt, director of social services for Macon County, said he is concerned about how the transformation will impact enrollment this year. While beneficiaries in the area will still receive care under the program, a lack of public knowledge on the subject leads many to allow brokers to choose their plans for them.
Betancourt urges beneficiaries to be proactive in their enrollment if they want to choose the plan that works best for them.
“Nationwide, what we know is that when states go into Medicaid transformation, they see roughly a 70 percent auto enrollment rate,” Betancourt said. “We’re on track right now in North Carolina to see roughly the same thing, which is unfortunate because that means those folks who are on Medicaid may not necessarily be enrolled with a provider who is tailored to meet their needs.”
The changes were meant to take effect gradually in several different regions, starting with 27 counties during the open enrollment period this past July. However, the state government’s failure to agree on a budget delayed the rollout, and now Macon County will receive the changes with everyone else on Oct. 14, with coverage taking effect on Feb.1, 2020. Managed care has already been adopted by 40 other states.
Just the same, this will be one of the biggest Medicaid reforms in North Carolina since the inception of the program. One in five North Carolinians, mostly children and people with disabilities, benefit from Medicaid and 1.5 million of the 2.1 million beneficiaries in the state will be impacted by these changes in the next few months. North Carolina Department of Health and Human Services secretary Dr. Mandy Cohen says that the department will prioritize making this a smooth transition for beneficiaries around the state.
“It’s a milestone,” Cohen said. “There’s been a lot of work and a lot of collaboration on this project for many years. It’s a huge effort with a lot of moving parts. We want to make sure our consumers who are experiencing this change have the time and space to understand the program and make the right changes for themselves and for their family.”
That being said, the Department of Social Services has had plenty off time to prepare for the change in enrollment procedures. Betancourt says that any beneficiaries in need of enrollment assistance will be well taken care of by the department.
“The good news is that our folks are ready,” Betancourt said. “There’s regular communication from HHS (Health and Human Services) about exactly what steps need to be taken next. Our income maintenance caseworkers are primed and ready to help folks get connected to the enrollment program.”
Open enrollment in Medicaid begins on Oct. 14. For more information on how enrollment works and how DSS can help, call the department at 828-349-2124 or visit the office at 1832 Lakeside Drive.
Additional information is available at files.nc.gov/ncdma/NC-Medicaid-County-Fact-Sheets.pdf.