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Medicaid Tailored Care Management (TCM) Announcement
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From NC Medicaid: In early June, we shared that during Open Enrollment for NC Medicaid, the Department closely monitored data indicating the active selections of Tailored Plan-eligible beneficiaries into Standard Plans. None of these beneficiaries were auto-enrolled in a Standard Plan. Toward the end of Open Enrollment, there was an increased uptick in the number of Tailored Plan-eligible beneficiaries who enrolled in a Standard Plan.
Through June 30, approximately 7,500 Tailored Plan-eligible beneficiaries made an active selection to enroll in Standard Plans, which may make them ineligible for services they are currently receiving, have recently received or may benefit from receiving. As noted in June, the Department determined that these beneficiaries would benefit from receiving additional choice counseling to ensure they are fully aware of the impact of the decision to leave NC Medicaid Direct and their LME/MCO to enroll in a Standard Plan -- including the potential loss of services. Standard Plan enrollment was stopped for these beneficiaries and all Tailored Plan-eligible beneficiaries who selected a Standard Plan. They currently remain in NC Medicaid Direct and their LME/MCO.
- On Aug. 4, 2021, approximately 7,500 beneficiaries will be mailed an exempt notice with an enrollment packet that includes information on their option to choose NC Medicaid Direct or an NC Medicaid Managed Care Health Plan.
- On Aug. 4, 2021, the Enrollment Broker (EB) will begin an auto-dialer campaign to inform these beneficiaries of their choices and directing them to call the EB if they would like to change to a health plan.
If a Tailored Plan-eligible beneficiary chooses to enroll in a Standard Plan, the Informed Consent process below will be executed:
- The beneficiary can fax an enrollment form (included in the Aug. 4 mailing) to the EB.
- An EB specialist will call the beneficiary to provide choice counseling that includes information on the coverage of Behavioral Health I/DD and TBI services only available in NC Medicaid Direct and LME/MCOs. [If the beneficiary calls the EB directly instead of faxing the form, the same process will be followed to provide counseling by phone.]
- The specialist will confirm their acknowledgement of the differences between the plans and affirm their plan choice.
- If the beneficiary still chooses a Standard Plan, the EB specialist will document the acknowledgement in the call center system, MAXeb.
- Aligned with NC Medicaid Transition of Care Policy requirements, Tailored Plan-eligible beneficiaries who elect to transition to a NC Medicaid Managed Care Health Plan will be under Transition of Care protections during this transition and will be designated as a Priority Population for care management.
- If the EB specialist is not able to reach a beneficiary who faxed or mailed an enrollment form, after three documented outreach attempts a notice will be mailed to the beneficiary that highlights the enrollment denial and their appeal rights.
- Beneficiary choice remains paramount and NC Medicaid will work to ensure that Tailored Plan-eligible beneficiaries fully understand their options. They will have the choice to enroll in a plan they feel best meets their needs.
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