Medicaid Transformation

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May 18, 2018 -- NCDHHS has issued its latest policy paper, "Supporting Provider Transition to Medicaid Managed Care." Comments are due June 11, 2018. A webcast will be offered in June. SIGN UP BELOW

Read the latest policy papers

"Supporting Provider Transition to Medicaid Managed Care" Webcast to be Held in June

The Department is offering a webcast on the policy paper "Supporting Provider Transition to Medicaid Managed Care." Presented by the Medicaid Managed Care Transformation team, the webcast will cover topics for providers, such as enrollment and credentialing; contracting guidance; conflict resolution; and payment and reimbursement.


To register:
1. Select one webcast to attend:
       Option 1: Friday, June 8, 2018 - 3:00-4:00 p.m.
       Option 2: Monday, June 11, 2018 - 1:00-2:00 p.m.
       Option 3: Thursday, June 14, 2018 - 3:00-4:00 p.m.
2. Fill out the form with the information you will use to enter the webcast.
3. A confirmation will be sent to you that includes the link to join the webcast on the day and time selected.

NOTE: Audio for this webcast uses computer or cell phone speakers. Dial-in audio is not available for this webcast. If you clicked the link to start the webcast:

  • On a computer, make sure the speakers are turned on and that the volume is turned high enough to hear or use earphones.
  • On a cell phone, treat the webcast as if you were on a phone call. Turn up the volume, and ensure the audio is on speaker or use earphones.

For those who cannot attend, the presentation will be posted on this website in late June. For questions or additional information, contact Sharlene Mallette.

North Carolina's Transformation to Medicaid Managed Care

The North Carolina Department of Health and Human Services (DHHS) is dedicated to improving the health and well-being of all North Carolinians.To help realize these goals, the Medicaid and NC Health Choice programs will be transformed from a predominantly fee-for-service delivery model to managed care in 2019, depending on state and federal approvals. The transformation to Medicaid managed care is the most significant change to the Medicaid program in over 40 years. To read more about this multi-year effort, click on a box below.

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.



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