(Map: NC Department of Health and Human Services)
Updated 7/14 with response from Atrium Health
The rollout of Medicaid managed care health plans for people with behavioral or developmental disabilities is delayed for a third time, the state Department of Health and Human Services announced Tuesday.
The launch of what the state calls “tailored plans” has been pushed back since last year. Last winter, DHHS pushed the start day to Oct. 1. In its Tuesday announcement, DHHS did not project a new launch date.
The tailored plans for people with disabilities who use Medicaid were to be akin to the Medicaid managed care plans the state launched in July 2021 for the general population. These care networks were to be managed by regional mental health offices, called Local Management Entities/Managed Care Organizations. LME/MCOs use state, federal and local money to pay for services for people with behavioral, intellectual, or developmental disabilities.
Without the tailored plans, people with disabilities who use Medicaid will continue to receive fee-for-service care. Tailored plans would have enrolled about 160,000 people, according to DHHS.
Large hospital groups were slow to sign network contracts, NC Newsline reported in February.
At a legislative committee meeting in March, LME administrators said they were having a hard time getting Atrium Health to sign contracts, the News & Observer reported.
Charlotte-based Atrium is a dominant health care provider in Mecklenburg and Forsyth counties.
Without adequate care networks, thousands of patients would have to find new healthcare providers and travel more than 30 miles to get to a primary care doctor, DHHS told legislators at the March meeting.
Atrium Health said in an email that it intends, eventually, to sign contracts.
“Our intent is to be contracted with each of the payors in this space to support this vulnerable patient population and its growing needs,” the Atrium Health email said. “As the state has noted publicly, there are gaps in the technological capabilities and operational readiness of the tailored plans. We look forward to being able to move forward when the department and the plans have resolved these issues.”
DHHS said in its press release that gaps in the provider network and the lack of a new state budget necessitated the delay.
The state budget includes Medicaid funds. Legislators failed to pass a new state budget by July 1, the beginning of the fiscal year.
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