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Medicaid Reform Minute #6: Patients outside of Standard Plans

Medicaid Reform Minute #6: Patients outside of Standard Plans

Medicaid Reform Minute #6: Patients outside of Standard Plans1

 

Patients in Special Populations will remain in fee-for-service until they are phased in to Managed Care at a later date. 

Special Populations to be phased in to Managed Care

 

Exempt patients may choose to join a PHP but are not required. Excluded patients will remain in fee-for-service Medicaid.

Exempt and Excluded Populations

 

Source: https://files.nc.gov/ncdhhs/documents/BeneficiariesInManagedCare_ConceptPaper_FINAL_20180309.pdf 

1Standard plans are outlined here: https://files.nc.gov/ncdhhs/documents/files/PopulationProfiles.pdf?oI2oB1itRV6ozGxXBzNkaPZPK1zG3jgx 
2Details on the Tailored Plan are outlined here: https://medicaid.ncdhhs.gov/behavioral-health-idd-tailored-plans
3More details pending
4Per source link, “Beneficiaries who are dually eligible for Medicare and Medicaid are currently excluded. The Department is contemplating phasing in dually eligible members to managed care, pending additional authority from the General Assembly.”


This Medicaid Reform Minute is provided courtesy of a partnership between Community Care of Western North Carolina and the Western Carolina Medical Society. For questions about this content, contact pmahoney@communitycarenc.org