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Medicaid Transformation: Watch for Outreach on Standard Plans

The NC Department of Health and Human Services (NC DHHS) is in the process of implementing Medicaid transformation in North Carolina. For people who use Medicaid as their health insurer, Standard Plans went live July 1, 2021, while Behavioral Health I/DD Tailored Plans are scheduled to launch July 1, 2022.

Most people with a diagnosis of autism are eligible for a Tailored Plan. Most of the support services in Tailored Plans will not be available under Standard Plans. You can read more about the differences in the plans in our blog entry.

NC DHHS noted that approximately 7,500 members who were eligible for Tailored Plans self-selected a Standard Plan. To ensure that people do not lose services, DHHS and the enrollment broker will be reaching out to these members to ensure they intended to make that switch. This outreach will include a mailing and a phone call from the enrollment broker beginning this week. The enrollment broker will provide counseling to the member to ensure that the best plan is chosen and will provide next steps for enrolling in the chosen Standard Plan or remaining with their regular NC Medicaid Insurance and receiving services through LME/MCOs (future Tailored Plans).

If this applies to you or a loved one, your benefits will remain as they are unless you take action to switch to a Standard Plan (United, Healthy Blue, WellCare, Amerihealth Caritas or Carolina Complete Health).  Services such as b3 funded respite, supported employment or IPRS developmental therapy/personal assistance or any Innovations Waiver services will not be available in Standard Plans.

Some members may have been auto-assigned to a Standard Plan; if members need to change plans because this occurred, they have until September 30, 2021 to change plans.

If you have questions, we can help. You can contact us at 800-442-2762 (press 2) for additional information. We know this is a complex issue to navigate and we are ready to answer your questions. Additional information is available at the links below:

NC DHHS Medicaid Transformation Website
Standard Plan Enrollment
NC Medicaid Beneficiary Portal
NC Medicaid Ombudsman


We will continue to share the latest on Medicaid transformation in North Carolina with you. You can read our full blog entry on the process.

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