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Medicaid Transformation

Key contacts and forms

No Wrong Door for Newborns first 90 Days

Children and Youth in Foster Care

Children and youth who were in foster care prior to July 1, 2021 and were enrolled in Medicaid should have remained in Medicaid Direct (fee-for-service). Their behavioral health services continue to be authorized and overseen by the regional LME-MCO associated with their county.

Children and youth who are enrolled in a Standard Plan (SP) but enter foster care after July 1, 2021 will need to be moved from that SP into Medicaid Direct. This is called “disenrolling” from the Standard Plan. This process is part of the Transition of Care Policy and initiated at the county level by the county Child Welfare/Foster Care department and the county Medicaid department.

The effective date of coverage by Medicaid Direct is retroactive to the first day of the month the child entered foster care. The behavioral health services for children and youth in foster care, enrolled in Medicaid Direct, will be authorized and overseen by the regional LME-MCO connected to their county.

A statewide Medicaid Foster Care Plan is slated for launchin 2024.

NC Medicaid Fact Sheets re: Children and Youth Transitioning from NC Medicaid Managed Care to Foster Care 

See Medicaid Transition of Care policy here

Transition of Care Protocols – Beneficiaries Disenrolling from Standard Plan due to Foster Care Enrollment: https://medicaid.ncdhhs.gov/media/10082/download?attachment

Fact Sheet - NC Medicaid Managed Care: Request to Move to NC Medicaid Direct Process https://medicaid.ncdhhs.gov/media/9947/download?attachment?attachment?attachment

More info here on the development of the statewide Foster Care Plan: https://medicaid.ncdhhs.gov/beneficiaries/specialized-foster-care-plan

Mental Health Assistance

  • NC-PAL is a free telephone consultation and education program to help health care providers address the behavioral health needs of pediatric and perinatal patients. Behavioral Health Consultants can respond to questions about behavioral health and local resources, and can connect providers to one of our on-call psychiatrists to assist with diagnostic clarification and medication management questions. NC-PAL will not bill you or your patients for telephone consultation. Calling NC-PAL does not establish a physician / patient relationship with an individual patient.
  • If your patient with a Standard Plan needs time-sensitive urgent mental health assistance and you need to contact them, please use the numbers below.  Again, this is NOT for routine use but only when you have a time-sensitive mental health concern.
    AmeriHealth: 1-833-712-2262
    Carolina Complete: 1-855-798-7093
    Healthy Blue: 1-844-594-5076 (TTY 711)
    United: 877-334-1141
    WellCare: 1-833-207-4240

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