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Carolina Complete Health Awarded Additional Region in Medicaid Managed Care

Date: 10/08/19

The North Carolina Department of Health and Human Services has expanded the regions awarded to Carolina Complete Health Inc. to serve as a prepaid health plan under the state’s transition to Medicaid managed care. In addition to serving regions 3 and 5 in the state, the provider-led health plan will also serve region 4.

DHHS and Carolina Complete Health Inc. have been working together to ensure the health plan is well-positioned to meet the state’s vision of providing a whole-person system of care that addresses both medical and non-medical drivers of health. As a provider led entity governed by physicians, CCH brings a unique perspective to Medicaid managed care. The agreement resolves CCH’s contested case pending at the Office of Administrative Hearings.

"Our top priority is meeting the health care needs of the people we serve, while being good stewards of public resources. As a physician, I understand the unique perspective that providers can bring to the health insurance market," said DHHS Secretary Mandy Cohen, M.D. "We look forward to our continued partnership."

"Carolina Complete Health is proud to be one of DHHS’ partners in pursuing its transformative, whole-person centered system of care, and we are very pleased to have the opportunity to bring our provider-led health plan to region 4,” said Chris Paterson, CEO of Carolina Complete Health.

Added Bob Seligson, CEO of the North Carolina Medical Society, "Our physicians are committed to providing leadership and governance for Carolina Complete Health to ensure that providers continue to have a central role as DHHS partners in improving the health and well-being of North Carolinians."

In addition to counties in regions 3 and 5, Medicaid beneficiaries in the following region 4 counties will now have the option to choose Carolina Complete Health Inc. as their health plan: Alamance, Caswell, Chatham, Durham, Franklin, Granville, Johnston, Nash, Orange, Person, Vance, Wake, Warren and Wilson.

Open enrollment for Medicaid managed care began in 27 counties in July. It will launch statewide on Oct. 14. In 2015, the NC General Assembly enacted legislation directing DHHS to transition Medicaid and NC Health Choice from fee-for-service to managed care. Under managed care, the state contracts with insurance companies, which are paid a predetermined set rate per person to provide all services. Transforming North Carolina’s Medicaid program to managed care is the most significant change made since its inception.