DHHS delays Medicaid tailored plans rollout DHHS delays Medicaid tailored plans rollout until December 2022

The launch of a key Medicaid transformation initiative in North Carolina - tailored plans for behavioral health recipients - has been delayed by an additional five months until Dec. 1, 2022.

Individuals who need certain services to address a serious mental illness, serious emotional disturbance, severe substance use disorder, intellectual or developmental disability, or traumatic brain injury, may be eligible to enroll in a tailored plan.

The state Department of Health and Human Services said in July that tailored plans could serve about 200,000 North Carolinians, or about 8.7% of the 2.3 million Medicaid recipients in the state.

DHHS has chosen the state's seven behavioral health managed care organizations (MCO) to administer the tailored plans, including Partners Health Management in Davie, Forsyth, Surry and Yadkin counties. The initial contract will last four years.

By comparison, there are between 1.4 million and 1.8 million North Carolinians participating in the Medicaid transition program overseen by four statewide prepaid health plans for their whole-body coverage, including long-term care and pharmacy services. That transition program debuted July 1.

"The updated implementation schedule recognizes community concerns that the COVID-19 pandemic has contributed to an increased need for behavioral health and intellectual/developmental disabilities services, which has placed added pressures at the state, MCO and provider level," DHHS said.

The five-month delay "will help balance the need to ensure a successful tailored plan launch with the imperative to provide current beneficiaries in the system high quality care."

Tailored plans can draw from federal Medicaid and state funding to support enrolled individuals.

"Integrating health care services for our members under one plan will allow us to further build on our mission of improving lives and strengthening communities," Partners chief executive Rhett Melton said in a statement.

Davidson and Rockingham are listed with Sandhills Center, along with current Sandhills members Guilford and Randolph counties.

Vaya Health, which has announced plans to take over Cardinal, is projected to cover Alamance, Alleghany, Ashe, Watauga and Wilkes counties in the Triad and Northwest N.C.

Stokes is among four counties whose assignment is considered as pending.

Clinics get state funding

In another development, the General Assembly approved $15 million in the 2021-23 state budget to support the N.C. Association of Free & Charitable Clinics.

The nonprofit group, based in Winston-Salem, is comprised of 72 medical, dental and pharmacy clinics that serve about a combined 80,000 uninsured and underinsured people in 86 counties.

The state budget also provides $15 million for community health grants and almost $9.5 million in funding for individual member clinics.

Senate Bill 105 also creates a joint legislative committee that will seek to find ways to increase access to health care.

Free and charitable clinics played a key role in North Carolina's health care response to the pandemic, providing COVID-19 testing and treatment while administering more than 35,000 vaccines.

The clinics primarily serve working North Carolinians who don't have employer-sponsored health insurance, earn too much to qualify for Medicaid assistance, and yet don't make enough to qualify for subsidies under the Affordable Care Act.

Many live with chronic diseases, such as diabetes and hypertension, which can increase absenteeism and put them at greater risk to contract and die from infectious diseases such as COVID-19.

"Free and charitable clinics have been around for decades, but today are playing an increasingly important role in helping our most vulnerable populations," Tony Price, the association's board chairman, said in a statement.

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