NCDHHS announces NC Medicaid Managed Care Children and Families Specialty Plan

RALEIGH — The North Carolina Department of Health and Human Services today announced Blue Cross Blue Shield NC was selected to operate the Children and Families Specialty Plan. A first-of-its-kind initiative, the CFSP 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.

Supporting children served by the child welfare system requires a close coordination across multiple systems and partners to ensure we support preserving families, reunification and securing permanency to ensure the best outcomes. Children and families in the child welfare system often find it hard to navigate getting the health care, social services and mental health care they need. The CFSP is designed to support this population by providing health care and mental health care coverage that follows the person — regardless of their geographic location or situation — and works across all these multiple systems.

“This plan will ensure there is a unified system of care and clear accountability when it comes to improving the health and wellbeing of our kids living with the most complex challenges,” said NC Health and Human Services Secretary Kody H. Kinsley. “We continue to improve how we serve people, so it’s more efficient and promotes better outcomes.”

The CFSP provides comprehensive coverage for all services provided by the Standard Plan in addition to most Tailored Plan services, such as 1915(i) Home and Community-Based Services and enhanced behavioral health and residential services. It also includes a broad range of behavioral health services such as outpatient therapy, inpatient treatment, and crisis and therapeutic residential options for children. Additionally, the CFSP is responsible for addressing unmet health-related resource needs, including housing, food, transportation, and interpersonal violence. The plan also covers pharmacy, long term services and supports (LTSS) and Intellectual/ Developmental Disability (I/DD) services.

At launch, the CFSP will operate statewide, offering robust care management to approximately 31,000 current and former foster care children and youth that will be enrolled automatically. Children of these eligible populations will also be automatically enrolled at launch and maintain enrollment while their parents are enrolled. In line with the plan’s goal to support and strengthen families, the plan will also be available to parents and family members of children and youth served by the child welfare system, including those receiving Child Protective Services (CPS) In-Home Services. NCDHHS is currently working on estimating this population size, and service to family members will be available no sooner than July 2026.

“As we put this plan into action the department recognizes the importance of implementing a whole-person centered, well-coordinated system of care that will support Medicaid-enrolled children, youth and families served by the child welfare system,” said Deputy Secretary of NC Medicaid Jay Ludlam.

Since 2021, NCDHHS has been leveraging the move to managed care for NC Medicaid to build an innovative health care delivery system that puts the health of beneficiaries at the forefront. Under Medicaid Managed Care, NC Medicaid Standard Plans and the Eastern Band of Cherokee Indians Tribal Option launched on July 1, 2021, followed by Behavioral Health I/DD Tailored Plans on July 1, 2024.

For information about the CFSP, please visit the Children and Families Specialty Plan webpage.

More information about the transition to NC Medicaid Managed Care can be found on the Medicaid website at medicaid.ncdhhs.gov/transformation.

The first CFSP contract was awarded to Blue Cross Blue Shield NC after a competitive selection process, and the term will last four years. Only entities operating as NC Medicaid Standard Plans, NC Medicaid Behavioral Health I/DD Tailored Plans and any other entity that meets the definition of a Prepaid Health Plan under NCGS § 58-93-5 or the 2023 Appropriations Act were able to bid on the contract.