The first-of-its-kind Children and Families Specialty Plan will go live on December 1, 2025. This is a single, statewide NC Medicaid Managed Care plan that will wrap Medicaid-enrolled children, youth and their families in the child welfare system with seamless, integrated and coordinated health care. 

NCDHHS and Blue Cross NC’s highest priority is to deliver a plan that meets the needs of the children and families of North Carolina. We are committed to building the systems and processes needed to ensure the Plan works for families and the counties that serve them. Since the contract was awarded in August 2024, we have been working together to and carefully planning to ensure the launch of the new plan goes smoothly and is ready to serve beneficiaries on day one.  

Over the next year, we will be working quickly and collaboratively to ensure that we are ready to support children and families by providing coordinated and comprehensive health care, including mental health care, that follows the person and works across multiple systems. 

We will also support providers in preparing to best serve this population under the new plan including extensive training and working with providers to address unmet health-related resource needs, including housing, food, transportation, and interpersonal violence. And, of course, we will collaborate with county leaders, DSS staff, community partners and stakeholders while preparing to support children and families in this new way of accessing care.  

What is the Children and Families Specialty Plan? 

• The Children and Families Specialty Plan is a new single, statewide Medicaid Managed Care plan that will wrap Medicaid-enrolled children, youth, and their families currently and formerly served by the child welfare system with seamless, integrated and coordinated health care. 
• The Plan will operate statewide, ensuring members can access the health care services they need, including mental health care, and continue to work with their doctors as placements may move them across the state.  
• The Plan is part of North Carolina’s commitment to improving the long-term health and well-being of children experiencing the child welfare system and to strengthen and support families. 
• To implement the Plan, NCDHHS will work with Blue Cross and Blue Shield of North Carolina (Blue Cross NC), who will manage it under the name Healthy Blue Care Together.  

• One, single statewide plan: The Plan will operate statewide as the single entity accountable for the health care of its members, simplifying processes and providing caregivers, providers, case workers and families with the information to provide the right care at the right time.  
• Informed by local needs: The Plan will collaborate with County DSS, local stakeholders and families to understand and respond to needs in each community. Care managers will be located within the community to support this work. 
• Prevention focused: The Plan will take a family-focused approach to care delivery to strengthen and preserve families, reduce entry and re-entry into foster care, and support reunification and other permanency plan options. 
• Comprehensive care: The Plan will increase timely access to a broad range of physical health, behavioral health, pharmacy, long-term services and supports (LTSS) and I/DD services, as well as unmet health-related resource needs for all members. 
• Coordinated care: The Plan will provide care management to all members to support integrated, whole-person care and facilitate coordination among service providers. It will also facilitate seamless transitions for members who experience changes in treatment settings, child welfare placements, transitions to adulthood and/or loss of Medicaid eligibility.  

• We will continue to share regular updates and also hold meetings with key stakeholders and organizations. 

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Your patients might be eligible! Two NCDHHS options to help them keep warm this winter!

NCDHHS' Low Income Energy Assistance Program (LIEAP) is a federally-funded program that provides for a one-time vendor payment to help eligible households pay their heating bills.

While households including a person aged 60 or older, or disabled persons receiving services through the NC Division of Aging and Adult Services were eligible to sign up in the month of December, all other households may apply now through March 31, 2025 or until funds are exhausted.

Households that meet the following criteria may be eligible:

• Have at least one U.S. citizen or non-citizen who meets the eligibility criteria.
• Meet an income test
• Have reserves at or below $2,250. (Resources will not be counted for this year's season from December 1, 2022-March 31, 2023)
• Be responsible for its heating costs.

More details about eligibility criteria

Getting tested for COVID-19 is about protecting yourself and your loved ones. To help ensure everyone has access to COVID-19 testing, the NC Department of Health and Human Services, in partnership with NC-based Labcorp, has launched a pilot program to provide 35,000 no-cost, at-home COVID-19 collection kits for North Carolinians who may face difficulties traveling to testing sites. If you are experiencing COVID-19 symptoms or think you may need to get tested, please get tested.

Provider appeal rights defined in the Standard Plan Contract Section V.D.5 Provider Grievances and Appeals, and the appeal processes outlined in the Prompt Payment Fact Sheet, include deadlines to submit appeals which may vary by Standard Plans, from 30 days to 365 days after the decision giving rise to the right to appeal.  

The third webinar in the Quality & Population Health Webinar series, formerly the Advanced Medical Home (AMH) Webinar series, will be held November 16 from 5:30-6:30 p.m. and will focus on PCP Assignments and Working with Clinically Integrated Networks (CINs). Following the presentations, there will be time for Q&A. This webinar series is designed to support providers, practice managers, quality improvement professionals, care managers, and CINs. We hope you can join us!

Please join NC Medicaid Chief Medical Officer (CMO) Dr. Shannon Dowler, along with all the NC Medicaid Managed Care plan CMO’s, for the October Back Porch Chat on October 21 from 5:30 - 6:30 p.m.

This webinar will review new COVID-19 surge response offerings from NC Medicaid, including a COVID-19 vaccine incentive program for NC Medicaid beneficiaries. It will also review how to help a patient who needs Behavioral Health and Individual Developmental Disabilities (I/DD) Tailored Plan behavioral health services move from a standard plan to NC Medicaid Direct.

In efforts at improving transparency, this webinar will provide an overview of a claims dashboard and clinical quality measures, and show results across plans in our first quarter of NC Medicaid Managed Care.

Finally, it will summarize the “latest and greatest” in recent Medicaid bulletins and answer your questions. Please use this link to submit your questions in advance.

Please join NC Medicaid Chief Medical Officer (CMO) Dr. Shannon Dowler, along with all the NC Medicaid Managed Care plan CMO’s, for the October Back Porch Chat on October 21 from 5:30 - 6:30 p.m.

This webinar will review new COVID-19 surge response offerings from NC Medicaid, including a COVID-19 vaccine incentive program for NC Medicaid beneficiaries. It will also review how to help a patient who needs Behavioral Health and Individual Developmental Disabilities (I/DD) Tailored Plan behavioral health services move from a standard plan to NC Medicaid Direct.

In efforts at improving transparency, this webinar will provide an overview of a claims dashboard and clinical quality measures, and show results across plans in our first quarter of NC Medicaid Managed Care.

Finally, it will summarize the “latest and greatest” in recent Medicaid bulletins and answer your questions. Please use this link to submit your questions in advance.

The North Carolina Department of Health and Human Services Division of Health Benefits and North Carolina AHEC, in conjunction with the five Medicaid managed care health plans, will host a Virtual Statewide Primary Care Quality Forum to help providers, practice managers, and quality managers succeed with Medicaid Managed Care quality initiatives.

This webinar will provide an overview of the Pilot program, with a focus on the essential roles and responsibilities of human services organizations that will provide Pilot services to eligible Medicaid members. The webinar will also highlight important upcoming implementation milestones and next steps. The session will be geared towards human services organizations that are interested in providing Pilot services, but is open to the public. There will be time reserved at the end for Q&A. 

To provide some clarity on prior authorization submissions, NCDHHS issued a NC Medicaid Managed Care Provider Update on Friday July 9, 2021 that includes  information about claims submission and prior authorizations under Medicaid managed care.