Medicaid Transformation

Latest News

March 18–DHHS released the Medicaid Managed Care "Final Policy Guidance for Behavioral Health I/DD Tailored Plans Eligibility and Enrollment."

Read the Final Policy Guidance

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.

NC Medicaid Managed Care Update

Secretary Mandy Cohen, M.D. hosted a Stakeholder Call on Wednesday, Feb. 6, 2019 to provide a Managed Care update and discuss the PHP contract awards.



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.