BCBSND Awarded Medicaid Expansion Contract

Blue Cross Blue Shield of North Dakota (BCBSND) was selected by the North Dakota Department of Human Services (DHS) to provide Medicaid Expansion Managed Care services across the state. This contract emphasizes BCBSND’s commitment to making a difference in the lives of North Dakotans—focusing on creating a healthier tomorrow.

This is a four-year contract with optional extensions beginning on January 1, 2022.

At BCBSND, our goal is to design and implement alternative payment models (also known as value-based care) as part of an overall reimbursement package to support the provider community in our collective efforts to deliver a sustainable, meaningful and reliable healthcare experience for members. BCBSND is excited to bring our alternative payment model experience with BlueAlliance into the Medicaid Expansion population. BCBSND will soon begin provider contracting efforts for Medicaid Expansion, including working with all existing BlueAlliance participants on participation in a Medicaid Expansion specific model to continue our focus on value-based care.

If you are currently enrolled with ND Medicaid and participating with BCBSND, you are eligible to participate in this network. We will offer network addendums outlining the terms of participation in the network to each eligible provider. BCBSND has been working with DHS to ensure our contract language complies with all state and federal requirements and anticipate distributing the addendum for your review within the next four weeks.

Frequently Asked Questions:

1. What is Medicaid Expansion?
North Dakota is one of 39 states (including DC) that elected to expand Medicaid to provide greater coverage to low-income adults. Since 2014, North Dakotans have had the option of Medicaid Expansion coverage. Now, BCBSND will bring this population under a managed care arrangement, which seeks to help all individuals reach their optimal health status. BCBSND will administer benefits to Medicaid Expansion residents ages 21 thru 64 with household incomes up to 138% of the federal poverty level.

2. Can I participate in Medicaid Expansion?
Yes, provided you are currently enrolled with ND Medicaid and a participating BCBSND provider. BCBSND will issue addendums to all BCBSND providers and only those eligible will be accepted.

3. Can we expect changes from how Sanford Health Plan handles Medicaid Expansion today?
Yes, we will incorporate many of the elements and methodologies currently used for the BCBSND commercial line of business into the Medicaid Expansion addendum design. For example, BCBSND uses APR-DRGs for inpatient payment and will use APR methodology with this line of business.

4. Will different providers have different rates?
Per North Dakota Century Code, BCBSND is required to reimburse providers within the same provider type and specialty at consistent levels and with consistent methodology.

If you have questions, please email prov.partners@bcbsnd.com for more information.