Managed Care to Medicaid
Managed Care to Medicaid Direct
The North Carolina Department of Health and Human Services (NCDHHS) has developed policies and procedures to support beneficiaries who transition between NC Medicaid Direct and NC Medicaid Managed Care delivery systems. The Transition of Care is designed to maintain continuity of care for each beneficiary and minimize the burden on providers during transition.
Acentra Health will help facilitate the transition of Medicaid services for beneficiaries who disenroll from a managed care plan and return to Medicaid Direct.
Beneficiaries
NC Medicaid’s vision for members transitioning between service delivery systems is to:
- Ensure beneficiary continuity of care
- Minimize provider abrasion
- Provide beneficiaries with information to make informed decisions about the least restrictive appropriate settings for their care
What causes dis-enrollment in managed care and transition to Medicaid Direct?
- Beneficiary is dually eligible
- Extended stay in a nursing facility – 90 consecutive days in a facility
- Foster Care
- Medically Needed
- Enrollment in PACE, CAP/C, or CAP/DA
IMPORTANT: If dis-enrolling from managed care and transitioning to Medicaid Direct, you should communicate
with your care providers so they can assist in the transition of services.
Common Questions
Starting Aug. 17, 2023, all LTSS Disenrollment Forms should be sent to Acentra Health via email to NCLIFTSSTCC@acentra.com with the subject line, ‘Disenrollment Form’.
IMPORTANT: Forms must be sent encrypted.
If a secure email is needed, please send an email, without the form attached, to the email listed above, and indicate that you need a secure email to send a disenrollment form.
A LTSS Disenrollment Form must be processed by a managed care plan and sent to Acentra when:
- A member is moving back to Medicaid Direct, and;
- Is being disenrolled in the next 30 days, and;
- Is receiving LTSS Services.*
*A disenrollment form will be requested from a health plan for members who have been approved to receive CAP services. This submitted form is required whether or not they previously received other LTSS services.
Acentra Health processes disenrollment forms within 24 hours, but may take up to 5 business days.
The health plan is responsible for communicating upcoming disenrollment's to providers. Acentra will send a courtesy communication to providers who are currently delivering LTSS services to the member and inform them of the planned disenrollment.
An individual is excluded from managed care and must receive care coverage by Medicaid Direct if any of the following apply, they become medically needy, enter foster care, have an extended stay in a nursing facility 90+ consecutive days, are enrolled in PACE, CAP/C or CAP/DA, or become dually eligible.
The form can be found on the Acentra Health website, on the resources and training page under the TCC tab or by simply clicking here: Disenrollment Form
The following information must be provided on the form in order for Acentra Health to be able to process it:
- Disenrollment Reason
- Disenrollment Date
- Member’s Name
- MID
- Health Plan Name
- Type of Residence
- Section B including the NPI
- Section C if section B indicates Nursing Facility
- Signature
For more information on Transition of Care and Disenrollment, please visit the DHHS website here - https://medicaid.ncdhhs.gov/care-management/transition-care
Providers
The North Carolina Department of Health and Human Services (NCDHHS) developed policies and procedures for Transition of Care to support beneficiaries who transition between NC Medicaid Direct and NC Medicaid Managed Care delivery systems. The Transition of Care is designed to maintain continuity of care for each beneficiary and minimize the burden on providers during transition.
Along with the established Transition of Care policy, the Department has established technology and process requirements for all stakeholders to support the Transition of Care design.
For details on the established technology and process requirements, please visit NC DHHS.
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