Sandhills Center
Member & Recipient Services:
1-800-256-2452
TTY:
1-866-518-6778
Behavioral Health Crisis Line:
1-833-600-2054
Nurse Line:
1-888-846-1058
Provider Pharmacy Line:
1-888-846-1062
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Medicaid Transformation

Medicaid Transformation

MEDICAID TRANSFORMATION: TRANSITION TO MEDICAID MANAGED CARE IN NORTH CAROLINA

Most people in North Carolina who get Medicaid services get them directly from the State, or they got behavioral health or intellectual/developmental disabilities (I/DD) coverage from a Local Management Entity-Managed Care Organization (LME-MCO), like Sandhills Center.

All of that is changing through Medicaid Transformation.

Because Medicaid Transformation may seem complex, this information can help guide you.  

HOW IS MY HEALTH CARE AFFECTED?

North Carolina is changing the way it manages care for most people who get Medicaid. The state is switching to a managed care model, rather than the fee-for-service model.

Eligibility for North Carolina Medicaid does not change. The services you use will still be covered by Medicaid. However, by December 1, 2022, most Medicaid members and State-Funded services recipients will have all of their physical and behavioral health needs covered by one plan – either a Standard Plan or a Tailored Plan.  

WHAT IS A STANDARD PLAN?

The Standard Plan, which went into effect on July 1, 2021, is a prepaid plan that covers physical and behavioral health services. Sandhills Center members who have switched to the Standard Plan chose a plan from one of the following companies:

WHAT IS A TAILORED PLAN?

The Tailored Plan also covers physical and behavioral health services. Under the Tailored Plan, coverage is for people who have intellectual/developmental disabilities (I/DD) or significant needs. The Tailored Plan helps Sandhills Center members and recipients get better health care that is “tailored,” or customized, to fit their unique needs. Under the Tailored Plan, some Sandhills Center members and recipients may be able to keep the plan they already have. Tailored Plans go into effect on Dec. 1, 2022.

HOW ARE THE STANDARD AND TAILORED PLANS SIMILAR?

Both plans cover:

HOW ARE THE STANDARD AND TAILORED PLANS DIFFERENT? 

WHAT HAPPENS WHILE I AM CHANGING TO MY NEW PLAN?

The North Carolina Department of Health and Human Services (NCDHHS) wants to make sure there are no problems or gaps in your services when you change to the new plans. Sandhills Center is working with NCDHHS so that your providers know what services are approved (known as authorizations) so you can keep getting services during the change to your new plan. We will talk with Medicaid members and State-Funded services recipients, their families, and providers so that issues are addressed right away.  

MEDICAID TRANSFORMATION TIMELINE 

WHAT IF I HAVE CONCERNS OR QUESTIONS?


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