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Medicaid Transformation

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Nov. 15–DHHS is committed to building a system of care that addresses both medical and non-medical drivers of health. NC's "Healthy Opportunities" is a groundbreaking program that will address non-medical drivers, starting with regional pilots.

More about Healthy Opportunities Pilots

Behavioral Health I/DD Tailored Plans Webinar

DHHS held a stakeholder webinar on Wednesday, Nov. 28, 2018 regarding the planning and implementation of the Medicaid Managed Care Behavioral Health I/DD Tailored Plans.
     Presentation (recording and transcript will be posted when available)

More information can be found in the CMS-approved 1115 waiver and related Oct. 26, 2018, stakeholder webcast documents, and in the Behavioral Health and I/DD Tailored Plan Policy Paper, issued Nov. 9, 2017.

North Carolina's Transformation to Medicaid Managed Care

The North Carolina Department of Health and Human Services is dedicated to improving the health and well-being of all North Carolinians. In support of this goal, the Medicaid and NC Health Choice programs will transition to Medicaid Managed Care in 2019--the most significant change to the NC Medicaid program in over 40 years. To read more, click on a box below.

DHHS Silent Period in Effect

Session Law 2018-49 directs the Department of Health and Human Services to issue a request for proposal (RFP) for Medicaid Managed Care Prepaid Health Plans (PHPs) by August 21, 2018. Therefore, DHHS is in a silent period from now through the award of the PHP contracts.

During the silent period, please note that Department employees may not discuss the PHP RFP. However, discussions on other topics may continue to be held as part of the normal course of business. This includes discussions related to issues of interest to DHHS and other health care stakeholders (e.g., the opioid crisis or promoting childhood vaccination), even if those topics may be in some way reflected in the RFP, provided that the discussions do not address the PHP RFP in any way.

Please direct procurement-related inquiries regarding the PHP RFP or Medicaid Managed Care PHPs to Kimberley Kilpatrick, Contract and Compliance Specialist.

Thank you for helping DHHS ensure all respondents have a fair and equitable opportunity to submit a proposal to be part of Medicaid Managed Care in North Carolina.



US Mail
Dept. of Health and Human Services, Division of Health Benefits
1950 Mail Service Center
Raleigh NC 27699-1950

Dept. of Health and Human Services, Dorothea Dix Campus
Adams Building Reception
101 Blair Drive
Raleigh NC

Provider Rate Floor and Reimbursement Scenarios

May 31, 2018–"Provider Rate Floor and Reimbursement Scenarios for North Carolina PHPs," prepared by DHHS, outlines reimbursement requirements for Prepaid Health Plans under various scenarios based on the interaction among rate floors, in-network service availability and a provider's in-network or out-of-network status in the context of North Carolina Medicaid managed care. The document addresses reimbursement for Medicaid covered benefits. Per member per month payment requirements for Advanced Medical Homes and care management functions are outside the scope of this document.