North Carolina seeking contracts operating retooled Medicaid

North Carolina state government has formally begun a search for insurance companies and health networks that want to care for most of the state's Medicaid patients.

Posted 8:45 p.m. Aug 9, 2018 — Updated 10:29 p.m. Aug 9, 2018

RALEIGH, N.C. — North Carolina state government has formally begun a search for insurance companies and health networks that want to care for most of the state's Medicaid patients.

The Department of Health and Human Services announced Thursday it's seeking proposals from entities interested in contracts with the state's overhauled Medicaid program starting in late 2019. DHHS Secretary Dr. Mandy Cohen says the awards are valued at $6 billion annually for up to five years, making it the department's largest procurement ever.

The General Assembly agreed in 2015 to shift Medicaid from a traditional fee-for-service program to one in which statewide managed-care companies or regional hospital and doctor networks get flat monthly amounts for each patient covered.

Four statewide contracts and six to 10 contracts covering six regions are expected to be awarded in February.

About 1.6 million of the 2.1 million people on Medicaid in North Carolina would be shifted to the new system by February 2020, Cohen said. Plans tailored to meet the special needs of the remaining 500,000 would be phased in over time, she said.

The contracts would guarantee that doctors wouldn't lose money in the transition to managed care, and a temporary floor would be put under the rates hospitals receive, Cohen said.

North Carolina is still working with the federal Centers for Medicare and Medicaid Services on a waiver that would allow the state to shift to a managed care system, she said.

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