A. MA-3255, North Carolina Health Choice, refers the caseworker to MA-3435, Community Care of North Carolina/Carolina Access, for instructions on enrolling and linking the NCHC children ages 6-18 to a CCNC/CA provider and primary home.
B. EIS will generate a daily notice to all NCHC recipients that have been linked to a CCNC/CA provider indicating the provider to which they have been linked along with the daytime and after hours’ phone number.
DATE: FEBRUARY 01, 2007
Manual: Family and Children’s Medicaid
Change No: 06-07
To: County Directors of Social Services
Effective: February 01, 2007
The General Assembly passed legislation requiring North Carolina Health Choice (NCHC) children be linked to the Community Care of North Carolina/Carolina Access (CCNC/CA) providers and networks. The linking of the NCHC children with a Community Care of North Carolina/Carolina Access provider and primary home will occur during the regular NCHC application and review process. The effective date for the counties to begin linking the NCHC children to a PCP is 2/1/07.
However, unlike the auto assignment procedures used for Medicaid children, do not auto assign NCHC children. NCHC children with a PCP number keyed into EIS by pull night will be linked to that PCP as of the first day of the following month. If the child is linked in EIS after pull, the child is not assigned until the first day of the next EIS processing month.
The information in EIS as of pull night will be sent to the fiscal contractor for NCHC in the following month after pull night. The fiscal contractor then generates payment to the providers and network in the next month.
In linking children to a PCP, the county caseworker must utilize the existing CCNC provider list to enroll NCHC children. Caseworkers do not need to switch children that already have a provider to a CCNC/CA provider.
The Managed Care staff has created a new exempt number (9900032) that caseworkers will use when the NCHC child already has a provider and that provider is not enrolled as a Carolina ACCESS provider. The caseworker must also use the new exempt number (9900032) if the NCHC child has no provider at all.
Do not give North Carolina Health Choice recipients the Carolina Access Brochure. The brochure refers to Medicaid; this population is not Medicaid. Carolina ACCESS, The Benefits of Being a Member, handout should be given to NCHC recipients. The Carolina ACCESS brochure must continue to be given to the Medicaid recipients.
EIS will generate a daily notice to all NCHC recipients who have changed their provider indicating the change and the new provider’s information to which they have been assigned.
This policy is effective February 01, 2007. You must key in a provider number for any redeterminations or applications approved on or after February 1, 2007. For those redeterminations or applications you worked on in January and did not address who was the medical provider, key in the new exempt number 9900032. For all other redeterminations and applications, determine if the child has a medical provider. If the child already has a medical provider, key the appropriate provider number.
If you have any questions, please contact your Medicaid Program Representative.
L. Allen Dobson, Jr., M.D., Assistant Secretary
for Health Policy and Medical Assistance
(This material was researched and written by Sandi Morrow, Policy Consultant, Medicaid Eligibility Unit.)
For questions or clarification on any of the policy contained in these manuals, please contact your local county office.