Advancing NC Whole Health Coalition Announces Agreement with AmeriHealth Caritas for Medicaid Transformation in North Carolina

Members of the Advancing NC Whole Health Coalition — Trillium Health Resources and Vaya Health — announced today they have signed a letter of agreement with AmeriHealth Caritas, a national leader in Medicaid managed care and other health care solutions for those most in need. The agreement will set the framework to develop integrated care solutions for North Carolina Medicaid enrollees under the State’s Medicaid Transformation plan.

AmeriHealth Caritas’ recognized expertise in managed care is centered on a member-focused approach that examines the social determinants that impact an individual’s health. This holistic model addresses issues such as food insecurity, job opportunities and education through community-based programs and integrated care management connecting behavioral health, physical health, and pharmacy. The Advancing NC Whole Health Coalition is a partnership of high-performing local management entities/ managed care organizations, which together serve a combined 715,000 Medicaid beneficiaries across 53 counties.

“The relationship between the Advancing NC Whole Health Coalition and AmeriHealth Caritas combines the strengths of the Coalition’s community-based behavioral health care with AmeriHealth Caritas’ best practices for delivering managed care across the nation,” said AmeriHealth Caritas Chairman and CEO Paul Tufano. “Our organizations care deeply about achieving the highest quality care for North Carolina Medicaid recipients and delivering the state’s desired outcomes.”

AmeriHealth Caritas will seek to win a Standard Benefit Plan contract in response to the recent request for proposals for Medicaid managed care prepaid health plans (PHPs). The State has indicated that it intends to award up to four contracts with PHPs to offer Standard Benefit Plans, which are Medicaid Managed Care plans that will serve most Medicaid and NC Health Choice beneficiaries, including adults and children. These Standard Benefit Plans will provide integrated physical health, behavioral health, and pharmacy services under Medicaid Transformation that is expected to launch in the second half of 2019.

Under this agreement, the Advancing NC Whole Health Coalition will provide certain functions necessary to help AmeriHealth Caritas build and grow a successful Medicaid health plan in North Carolina. This solution will combine AmeriHealth Caritas’ 35 years of experience in Medicaid managed care across the country with the Coalition’s expertise in successfully managing behavioral health and intellectual and developmental disabilities services for North Carolina Medicaid enrollees since 2012.

AmeriHealth Caritas currently provides full-risk Medicaid managed care in Delaware, Florida, Louisiana, Michigan, Pennsylvania, South Carolina, and the District of Columbia. In a number of those markets, an AmeriHealth Caritas member company was an inaugural health plan under the state’s Medicaid managed care program.

A joint statement released by Coalition CEOs Rob Robinson, Leza Wainwright and Brian Ingraham stated, “As mission-focused organizations offering targeted programs for Medicaid-eligible individuals in our various regions, we share a vision of how effective integration of physical and behavioral health can help deliver positive outcomes for our members. Combining a track record of proven experience and complementary competencies with a shared mission to serve complex, at-risk populations will ensure the best possible foundation to exceed the goals of NC Medicaid Transformation. We look forward to collaborating with AmeriHealth Caritas to help Medicaid members in North Carolina get care, stay well and build healthy communities.”

About AmeriHealth Caritas

AmeriHealth Caritas is one of the nation’s leaders in health care solutions for those most in need. Operating in 15 states and the District of Columbia, AmeriHealth Caritas serves approximately 5.3 million Medicaid, Medicare and Children’s Health Insurance Program (CHIP) members through its integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 35 years of experience serving low-income and chronically ill populations. AmeriHealth Caritas is part of the Independence Health Group in partnership with Blue Cross Blue Shield of Michigan. For more information, visit www.amerihealthcaritas

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Trillium Health Resources is a leading specialty care manager (LME/MCO) for individuals with substance use, mental illness and intellectual/developmental disabilities in 26 counties in eastern North Carolina. Trillium’s mission is to transform the lives of people in need by providing them with ready access to quality care. We take a person-centered approach to health and wellbeing, coordinating care across multiple systems to achieve improved health outcomes, quality of care and efficient use of resources. Trillium is investing in innovation to meet the unique needs of the individuals and communities we serve, and remains focused on delivering the right services, in the right amount, at the right time. For more information, visit

Based in Asheville, N.C., Vaya Health manages public funds for mental health, substance use disorder and intellectual or developmental disability services in 23 western North Carolina counties: Alexander, Alleghany, Ashe, Avery, Buncombe, Caldwell, Cherokee, Clay, Graham, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Polk, Rutherford, Swain, Transylvania, Watauga, Wilkes and Yancey. Access to care and crisis assistance are available 24/7 at 1-800-849-6127. Learn more at