FAYETTEVILLE, N.C. (WNCN) — Changes to North Carolina Medicaid patients go into effect July 1. Some people may now be re-assigned to new providers without knowing so.
The state is shifting more than a million people to the Medicaid managed care program.
“I’m not lying to you when I say I’m really scared about the health of the patient,” said Bart Fiser, Vice President of Corporate Revenue Cycle and Managed Care at Cape Fear Valley Health.
Under the new Medicaid managed care program, the state is handing off care to five private insurance companies. Those companies have assigned primary care physicians to those patients. It’s supposed to save the state money and keep patients out of the emergency room.
“The long-term goal is to get them into primary care where you can work on wellness rather than chronic care management,” said Fiser.
The message about the change seems to have been lost along the way.
A survey from North Carolina for Better Medicaid found 2 in 3 people knew very little or nothing about the changes.
“I’m just nervous that they’re not going to have the information that they need and they’re going to show up and not really know what to do,” said Fiser.
The state did give patients a time frame to choose their own plans and providers. However, a state report from May shows just 15-percent of people self-enrolled into a plan of their choice. The remaining 85-percent were auto-enrolled.
“It makes me nervous to the physicians out there that run these individual practices on how they’re going to handle this onslaught of patients that may not have the right cards. They’re going to be doing a lot of eligibility checks,” said Fisher.
The state said they prioritized existing doctor-patient relationships but in some cases couldn’t keep them together. Now, patients have a 90-day grace period after July 1 to receive care if they show up to a now out-of-network provider.
If your doctor was changed under the transition, you have until the end of September to request to go back to that doctor. That change is possible as long as the doctor is within a health plan under managed care program.
After that grace period only special circumstances will allow for a change.
“After the 90 days, they will not be able to be seen there,” Fiser said. “[They] potentially won’t be able to get their prescription filled, there’s a whole long line of things that can happen,” Fiser said.
Fiser said it could be up to six months before everything gets straightened out.
“Some of the plans have been issuing cards that have the wrong physicians on it and they’ve had to re-issue cards in the last week,” he said.
To ensure you keep receiving timely care, check to see that you have the right insurance card. Fiser said your safest bet is to call before you show up to make sure you are covered and not stuck paying out of pocket. Visits to the emergency room will not be denied if the hospital is out of your network.
For questions about your new plan, you can call the Enrollment Broker at 833-870-5500 (TTY: 833-870-5588). You can also visit the NC Medicaid plans website by clicking here.