From RADAR on Medicare Advantage

The North Carolina Dept. of Health and Human Services (DHHS) on Aug. 9 released its long-awaited request for proposals from managed care organizations hoping to be the first to serve the state's Medicaid program. Major insurers such as Aetna Inc., Anthem, Inc. and Centene Corp. have already formed partnerships with providers and other local entities in North Carolina as the state prepares to move some 1.5 million enrollees from fee for service to managed care beginning in November 2019.

"Due to the limited number of statewide greenfield opportunities in the pipeline, this RFP is expected to be highly competitive with nearly all publicly traded MCOs expected to bid on the business," wrote Barclays Capital securities analyst Steve Valiquette.

North Carolina is the largest state in terms of Medicaid expenditures — approximately $13 billion — that has not yet moved to managed care, according to Barclays. Once fully implemented, Barclays estimates that individual plan revenue could be between $1.5 billion and $2.5 billion.

DHHS will enter into capitated Prepaid Health Plan (PHP) contracts to cover all Medicaid and NC Health Choice services. This RFP procures Standard Benefit Plans that will provide integrated physical health, behavioral health and pharmacy services to the majority of Medicaid and NC Health Choice beneficiaries with lower intensity behavioral health needs. Subject to CMS approval, the state will later procure and establish Tailored Plans that would provide specialized care to people with higher behavioral health needs.

DHHS plans to award four statewide contracts — which may be awarded to commercial plans or Provider-Led Entities — and up to 12 regional contracts with PLEs.

The state anticipates making contract awards in February 2019 and launching the program in two phases, starting with a November implementation for Phase 1 regions and a February 2020 launch for regions in Phase 2.

Subscribers may read the in-depth article online. Learn more about subscribing to AIS Health's publications.