Open enrollment for Medicaid beneficiaries extended

Sep. 5--HENDERSON -- A budget impasse has prompted the N.C. Department of Health and Human Services to extend the deadline for Medicaid recipients in the Tri-County to enroll in a managed care plan.

Instead of rolling out managed care services as planned on Nov. 1, the region and much of the rest of north-central North Carolina will join a statewide rollout on Feb. 1, DHHS officials announced this week.

Officials adjusted the timeline because DHHS can't "implement critical actions to go live with managed care under the current continuing resolution budget," according to the department's announcement. The change only affects counties that were in Phase 1 of a planned two-phase rollout. The Feb. 1 target "for statewide implementation remains unchanged," DHHS said.

The announcement came as local officials were preparing to meet the Nov. 1 deadline.

DHHS and local social-services departments are organizing the switch to managed care on orders from the N.C. General Assembly. The Republican leadership of the legislature wants to save money on Medicaid and believes the way to do that is to work through managed-care groups rather than allowing doctors, hospitals and clinics to bill the program individually.

While "most recipients will see no changes" to the services they've been receiving, they have to enroll through a health plan to continue receiving them, according to Denita DeVega, director of the Vance County Department of Social Services.

A health plan, through Medicaid, is a group of doctors, hospitals and other providers that'll work together to supply "health care to meet collective needs," the Vance department said. The "goal is for every medical service -- physical health, mental health and medicine -- to come through the same health care plan."

Recipients should select a primary care provider to work with, "which could be in the form of a family doctor, clinic or other health care provider." Those who already have one can keep the one they have, or choose a new one.

With the delay at the state level, Medicaid recipients in Vance County have until Dec. 13 to enroll in a health plan.

If a recipient hasn't chosen a health plan or primary care provider by Dec. 13, one will be chosen for him or her. However, "depending on the type of health services needed," a small number of recipients will be able to continue enrollment through N.C. Medicaid Direct.

Vance Social Service is also planning to hold an information session for local recipients, to guide them "through the process of selecting a health plan and primary care provider," according to a department news release.

This evening session, which will be held at the local DSS office at 350 Ruin Creek Road, is scheduled for Sept. 10 from 6 p.m. until 8 p.m.

Officials advise recipients who are senior citizens to bring a "trusted family member" or friend to help in the selection process.

For people unable to attend, an outreach specialist is available for assistance at DSS 8:30 a.m. until 4 p.m., Monday through Friday. Help shall "be offered on a first-come, first-served basis."

The General Assembly voted in 2015 to order the switch to managed care, where the state contracts with insurance companies it pays a predetermined, set rate per person to supply all medical services.

But the change has become caught up in the dispute between General Assembly leaders and Gov. Roy Cooper, who wants Medicaid eligibility expanded in the way many other states did earlier this decade following passage of the federal Affordable Care Act.

Republican leaders, in the N.C. Senate in particular, are unwilling to negotiate on the point. So work on the full fiscal 2019-20 state budget stalled. Legislators have passed a few incremental budget bills to implement pay raises for some state-paid workers, but Cooper last week vetoed another that would have supplied money for the Medicaid managed-care change.

The 27 counties that had been lined up to go live with managed care on Nov. 1 included Vance, Warren, Granville and Franklin counties, plus Alamance, Alleghany, Ashe, Caswell, Chatham, Durham, Davidson, Davie, Forsyth, Guilford, Johnston, Nash, Orange, Person, Randolph, Rockingham, Stokes, Surry, Wake, Watauga, Wilkes, Wilson and Yadkin.

DHHS officials have said "ongoing budget uncertainty has been an impediment to health plans finalizing contracts with doctors and health providers" and that an "essential component of a well-running managed care system is the strength of the health care network available to beneficiaries."

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