What is Medicaid Transformation?

The North Carolina Department of Health and Human Services is dedicated to improving the health and well-being of all North Carolinians. In support of this goal, the Medicaid and NC Health Choice programs are transitioning to Medicaid Managed Care this year. This is the most significant change to the NC Medicaid program in over 40 years.

Over a five year period beneficiaries will transition to one of two types of prepaid health plans (PHP’s), customized to the population they serve.

The two plans are Standard Plans and Tailored Plans.

Standard Plans will launch starting in November 2019 in two regions of North Carolina (including Wilson County in Eastpointe’s service area) and the remaining regions will launch in February of 2020. They will serve the vast majority of Medicaid beneficiaries.

Behavioral Health and Intellectual/Developmental Disability (BH/IDD) Tailored Plans will launch in July 2021 and will serve individuals with more serious behavioral health disorders (serious mental illness (SMI), serious emotional disturbance (SED), and/or substance abuse disorders (SUD), intellectual/developmental disabilities (I/DDs), and traumatic brain injuries (TBIs).