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Managed Care Information for Consumers
CCNC/CA Information for Providers
Health Check Information for Consumers
Chris Collins, Assistant Director
Deputy Director, Office of Rural Health and Community Care
Phone: 919-855-4780
Fax: 919-715-0844 or 919-715-5235
Community Care of North Carolina/Carolina ACCESS (CCNC/CA) is the primary care case management health care plan for a majority of Medicaid citizens of this state. The objective of CCNC is to create community health networks to achieve long-term quality, cost, access and utilization objectives.
Overview and History of Medicaid Managed Care in North Carolina
CCNC/CA is one of seven winners of a prestigious Innovations in American Government Award
The Managed Care section oversees the Managed Care Customer Service Unit, Program Operations, Risk Contract, and Health Check.
Betty West, Manager
Phone 919-855-4780
Fax 919-715-0844
DMA's Managed Care Customer Service Unit provides information to callers regarding Medicaid covered services or resources that are available to help resolve problematic issues and/or navigate the Medicaid health care system. A majority of callers are Medicaid recipients; however, service providers also call for assistance with situations that involve the delivery of care to Medicaid recipients.
The Medicaid Ombudsman is part of the Customer Service unit and works closely with other sections within DMA to ensure current and accurate information is provided. The ombudsman is bilingual and handles calls where Spanish is the preferred language. The ombudsman responds to many of the inquiries made to Office of Citizen Services by North Carolina citizens when Medicaid is the subject of inquiry. There is a close collaboration with the Office of Citizen Services to coordinate the Medicaid information being given to citizens who call the CARE-LINE. The ombudsman also keeps the CARE-LINE updated on Medicaid covered services so that they have the information to handle basic Medicaid inquiries.
The CARE-LINE refers Medicaid calls that are more complex to the CS unit. The CS unit collaborates with CA/CCNC networks on quality health initiatives to improve the education and distribution of information to Medicaid recipients.
Customer Service Representatives also work with local departments of social services to maximize enrollment by contacting eligible Medicaid recipients and enrolling them into the Carolina ACCESS program. The outreach effort was piloted in Cumberland County. Currently, outreach counties are working with 3 counties: Orange, Caswell, and Gaston.
The Customer Service (CS) Unit creates, reviews, and analyzes reports used to track program status and performance.
CS partners with program operations in identifying the necessity and scope of program policies and procedures. CS has a in developing or modifying and implementing policies that enhance access to necessary and quality health care for recipients of Medicaid.
Darryl Frazier, Manager
Phone 919-855-4780
Fax 919-715-0844
Program Operations in conjunction with Customer Services is responsible for the day to day operation of North Carolina's Managed Care programs including CCNC/CA and Health Check. Program Operations is comprised of the Program Operations Manager, 6 regional Managed Care Consultants and 2 regional Health Check Consultants. Specific responsibilities of the unit include:
Darryl Frazier, Manager
Phone: 919-855-4780
Fax: 919-715-5235
North Carolina expanded the federal Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program (which has been in existence since Medicaid began) to form the Health Check program in 1993. EPSDT serves as the standard for providing healthcare to Medicaid recipients under the age of 21. The purpose of the Health Check program is to facilitate regular preventive medical care and the diagnosis and treatment of any health problem found during a screening. There is no separate enrollment in Health Check. If someone is eligible for Medicaid and is under the age of 21, they automatically receive Health Check services.
Health Check Automated Information and Notification System (AINS)
The following Health Check strategies have been implemented statewide:
An integral part of the Health Check program is a special initiative called the Health Check Outreach Project. Ninety-seven counties participate in this outreach effort by having specially trained Health Check Coordinators work to reduce barriers and improve access to preventive health services. The Division of Medical Assistance works in close collaboration with the Division of Public Health’s (DPH) Women’s and Children’s Health Section to provide guidance to the project counties.
