Medicaid Transformation

Pregnant woman

Latest News

June 22, 2018 -- Per HB 403, NCDHHS issued a BH IDD Tailored Plans implementation plan report to the NC Joint Legislative Oversight Committee on Medicaid and NC Health Choice.

Read the JLOC report

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.

Contact

Email: Medicaid.Transformation@dhhs.nc.gov

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

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