1. NAME OF PROGRAM: Carolina ACCESS (Medicaid Managed Care)

2. PURPOSE OF PROGRAM: To provide a more efficient and effective health care system for Medicaid recipients. Carolina ACCESS is a managed care program for Medicaid recipients. Like other managed care programs, Medicaid recipients choose a primary care physician who delivers and coordinates all their health care needs. If the recipient has a medical problem that requires specialty care, the primary care physician is responsible for referring the recipient to the appropriate specialist. Recipients choose a doctor from a list of participating physicians who are contracted with the Carolina ACCESS Program.

3. APPLICATION PROCEDURES: Recipients are enrolled in Carolina ACCESS at the time of their initial certification or re-certification for Medicaid. Each eligible recipient chooses a primary care provider from a list of participating providers. Each family member may have a different PCP if they so choose. Recipients may change providers by contacting the Managed Care Representative.

4. ELIGIBILITY REQUIREMENTS: All Medicaid recipients are required to participate in the Carolina ACCESS Program unless they are receiving Medicaid in the following categories:

1. Medicare Qualified Beneficiaries (M-QB), Medicaid for Refugees (M-RF), Refugee Assistance (R-RF), Special Assistance to the Aged (S-AA), or any recipient in deductible status.
2. Medicaid for the Aged (M-AA), Medicaid for Pregnant Women (M-PW), Medicaid for Foster Care Children (H-SF), Medicaid for Foster Care Children (I-AS), and any Medicaid recipient who is also eligible for Medicare (dually eligible) are in an optional category and have the right to choose whether they want to participate in the program.

5. OTHER PROGRAM DETAILS: Cabarrus County is a pilot county for the ACCESS III demonstration project. The Cabarrus Community Care Plan is a community partnership involving physicians, Northeast Medical Center, Cabarrus Health Alliance, Department of Social Services and other community providers. The Cabarrus Community Care Plan is developing care management initiatives that achieve access, quality, utilization and cost objectives by improving the management of patient care. These initiatives aim to assess the needs and severity of our Medicaid population in order to target care management activities. The successful implementation of the care management processes will help to better manage our Medicaid populations and improve health care outcomes.

6. DATE OF INFORMATION: April 20, 2001