We found out earlier this week that the NC Department of Health & Human Services will begin important changes in the Health Choice program effective January 1, 2014.
Here is our understanding:
- Effective January 1, 2014, children age 6 to 19 who are above 107% of poverty but less than 133% will be moved from Health Choice and enrolled in North Carolina’s Medicaid program. This is the program that is operating under the waiver – the 10 MCOs in NC.
- This covers approximately 70,000 children. We do not know how many of those are receiving behavioral health/substance abuse treatment.
- IF – you are already enrolled as a provider for the MCO covering a child you are treating, you will bill through that MCO for any services beginning January 1, 2014. You should contact that MCO to coordinate this process.
- IF – you are seeing a HealthChoice child who fits in this category that is being transferred to Medicaid effective January 1 and you are NOT enrolled with the MCO that will cover that child, you should contact the MCO network manager to work out whatever arrangement the MCO and you decide best fits the child’s needs. That might be that you enroll or do a single case agreement.
PLEASE NOTE – you will not be able to bill directly to Medicaid for any service provided beginning January to a Health Choice child who is moved to Medicaid.
Listed below are the MCO numbers that are on the Medicaid health insurance cards.
|LME-MCO||TOLL FREE NUMBER|
Alliance Behavioral Health
|Cardinal Innovations Healthcare Solutions||1-800-939-5911|
|CenterPoint Human Services||1-888-581-9988|
|East Carolina Behavioral Health (ECBH)||1-877-685-2415|
|Partners Behavioral Health Management||1-888-235-4673|
|Smoky Mountain Center||1-800-849-6127|
As I understand it, DHHS has asked the MCOs to work with providers, including psychologists and other licensed behavioral health professionals to assure a smooth transition for these children. I would appreciate hearing from you if you encounter any issues with the transition.
Mark Ezzell, Executive Director
Addiction Professionals of North Carolina