Topics Related to Medicaid Direct

Process Change for NC Medicaid Direct Private Duty Nursing Authorizations

Redistributing Previously Approved Shared Private Duty Nursing Hours Among Service Providers without a New CMS-485 or PDN Ordering Provider Order, Effective September 1, 2026

Action Required: Drug Enforcement Administration Certification Required for Prescribing Controlled Substances

Beginning Nov. 1, 2026, Pharmacy Claims for controlled substances will be denied without an active certification on their NCTracks provider enrollment record.

Claim submission process when eligibility is retroactively updated

Reminders for NC Medicaid Managed Care, NC Medicaid Direct and Medicare.

NC Medicaid Off-Cycle Change to the Preferred Drug List Due to Lantus SoloStar Pen Shortage

Effective July 24, 2026, Basaglar® U-100 KwikPen® moved to Preferred status due to reported shortage of Lantus SoloStar pen.

Utilization Management by NC Medicaid Managed Care Health Plans – August 2026

This bulletin replaces in full the December 2025 Utilization Management by Managed Care Plans Aligned with Food and Drug Administration Labeling bulletin.

Updates to Rate Increase for Personal Care Services and the Community Alternatives Program

This Medicaid bulletin replaces in full the July 31, 2026, Rate Increase for Personal Care Services and the Community Alternatives Program bulletin.

Rate Increase for Personal Care Services and the Community Alternatives Program

This Medicaid Bulletin has been completely replaced by an updated version published on Aug. 4, 2026. Please see the Updates to Rate Increase for Personal Care Services and the Community Alternatives Program bulletin, for the latest information.

Update to North Carolina Medicaid Due Process/Appeals Unit Fax Number for Claim Review

The updated fax number is effective as of July 15, 2026. This bulletin applies to NC Medicaid Direct.

Some Qualified Medicare Beneficiaries Now Have Coverage for Family Planning Services

For eligible individuals, NC Medicaid will now pay for Family Planning services in addition to Medicare premiums and cost sharing.

Clinical Coverage Policy Update 1A-20 Sleep Studies and Polysomnography Services

Amendments to Clinical Coverage Policy 1A-20, expanding medical necessity criteria and updating coverage for sleep studies and polysomnography services are effective July 1, 2026.