Guidance for the 2026 – 2027 COVID-19 vaccine for NC Medicaid.
Topics Related to Division of Health Benefits
This bulletin provides guidance on the 2026 – 2027 influenza season for NC Medicaid.
Updated guidance on the Legally Responsible Individual as the Paid Caregiver in the CAP/C HCBS waiver Consumer Directed model.
Clarifications to providers on concurrent billing for Clinical Coverage Policy 8F.
Revisions to areas include definitions, eligibility and coverage criteria, specific criteria covered, transition and discharge planning and more.
Providers should take advantage of the 70-day timeframe given to ensure completion without adverse action.
Appointment dates and times will no longer be scheduled for provider site visits
NC Medicaid Managed Care Incremental Innovations Waiver DCW Rate Increases effective October 1, 2026, retroactive to July 1, 2026.
Effective July 1, 2026, NC Medicaid launched a targeted expansion of School-Based Services by Local Education Agencies.
The Centers for Medicare & Medicaid Services released the 2027 ICD-10 code list, Effective Oct. 1, 2026.