by Brieanne Lyda-McDonald, MSPH

Hurricane Helene left many communities in Western North Carolina (WNC) with a wide range of needs for immediate relief and long-term recovery. To address needs related to health care access for individuals enrolled in Medicaid, the North Carolina Department of Health and Human Services (NCDHHS) has established various temporary flexibilities effective from September 26, 2024, through December 31, 2024. These include:

• “A temporary, expedited enrollment process for health care providers to become a NC Medicaid provider due to a natural disaster.” Providers not already enrolled can find details on the NCTracks Provider homepage [1].
• “NC Medicaid will reimburse providers for medically necessary drugs and services, equipment and supplies, provided during the Hurricane Helene emergency without prior authorization (PA)” [1].
• “NC Medicaid, in partnership with the DHHS Division of Mental Health, Developmental Disabilities and Substance Use Services (DMHDDSAS) and the Division of Health Service Regulation (DHSR), is temporarily modifying its Behavioral Health and Intellectual and Developmental Disability clinical coverage policies to better enable the delivery of care to NC Medicaid beneficiaries impacted by Hurricane Helene.” Specific services are detailed in this NCDHHS bulletin [1].
• “NC Medicaid Direct has temporarily modified its Family Planning CCP, 1E-7 to better enable the delivery of remote care to Medicaid beneficiaries. Both new and established MAFDN-eligible beneficiaries may receive family planning services, including a new patient visit, in-person or via telemedicine, and an annual exam is not required" [1].
• “Private Duty Nursing (for pediatric and adult beneficiaries) may be provided without prior authorization (PA) for NC Medicaid Direct and NC Medicaid Managed Care beneficiaries" [1].
• “NC Medicaid Direct and NC Medicaid Managed Care encourages local health departments to provide maternal support services in-person when it is safe to do so; however, if an in-person or home visit is not feasible, eligible providers may conduct maternal support services with new or established patients via telemedicine" [1].
• “NC Medicaid Direct and NC Managed Care will allow temporary telehealth flexibilities for the delivery of select outpatient specialized therapies (OST) evaluation and treatment services" [1].
• “NC Medicaid enrolled pharmacy providers have been approved to override [prior authorization] requirements for people impacted by the storm" [1].
• “[T]o support providers during Hurricane Helene, the eligibility requirements at 42 CFR 482.58(a)(1)-(4), “Special Requirements for hospital providers of long-term care services (swing-beds)” have been waived. This allows hospitals to establish skilled nursing facility (SNF) swing beds payable under the SNF prospective payment system (PPS) to provide additional options for hospitals with patients who no longer require acute care but are unable to find placement in a SNF" [1, 2].

The table below shows the total number of Medicaid enrollees in each of the 25 WNC counties included in the Governor’s disaster declaration in the most recently available month [3]. In June 2024, there were nearly half a million (457,600) individuals enrolled in Medicaid in these counties, with 18% of those being enrolled through expanded Medicaid eligibility.