Low uptake as open enrollment closes on multibillion-dollar change in NC Medicaid

Those who don't pick a plan will have one selected for them in a process that will prioritize, but won't guarantee, that they keep the same primary physician. The 1.6 million people changing plans will then have until Sept. 30 to change their plan, and primary care provider, for any reason.

As of Wednesday, 155,954 people had taken advantage of the two-month open enrollment period.

State lawmakers who pressed the legislation that called for the shift said they're not worried about the apparent lack of interest. Other states that made a similar move saw about 20 percent of people pick their own plans, and perhaps the pandemic lowered North Carolina's numbers further, Sen. Ralph Hise, R-Mitchell, said Thursday.

Rep. Donny Lambeth, R-Forsyth, said much the same thing, though he called the initial numbers "disappointing."

With open enrollment drawing to a close, the rubber meets the road. Blue Cross Blue Shield of North Carolina and other companies that won multibillion-dollar management contracts will have a larger role in the state's single most expensive program, managing health care plans in a move expected to provide cost certainty, if not save the state money.

Each company gets a set amount in state funds, based on average per-person rates. If they stay under caps, they keep profits. If costs overrun, the companies are at risk.

The state budgeted just over $2 million to pitch beneficiaries on open enrollment, running ads in English and Spanish since early March. Most of that went toward TV and radio ads, along with posters and online ads, including social media, according to the Department of Health and Human Services, which oversees the program.

The state also mailed notices at the start of open enrollment, DHHS said, and sent a reminder postcard April 15. It also issued a number of press releases and has been holding webinars for months with doctors and various groups to spread awareness.

After Sept. 30, beneficiaries will be locked into their new plans, unless there is special reason to change, until the next Medicaid recertification date.

"No matter what plan a member is enrolled in (whether they select a plan or are auto-enrolled), they will have access to the same services that Medicaid covers today," DHHS said in a news release this week. "Health plans may also offer enhanced services to plan members. It is important to also note that Medicaid eligibility rules will not change because of Medicaid Transformation."

The state encourages people to pick a plan themselves.

Don Taylor, a Duke University professor who has followed Medicaid transformation closely in North Carolina, said he wasn't worried about the slow uptake rate. The last day of open enrollment on Friday will probably see more sign-ups than any other day, he said in an email, and default selections aren't uncommon in the insurance industry, including in employer-sponsored plans.

"COVID19 has sucked all the oxygen out of the room, and getting consumers/patients to do what you want them to do is hard, always," Taylor said in an email. "But it does undermine the concept that people are eager to shop for their health insurance."