An out-of-date NCTracks provider record jeopardizes continued NCDHHS program participation.
Topics Related to Medicaid Direct
For NC Medicaid and Division of Mental Health, Developmental Disabilities, and Substance Use Services (DMHDDSUS) State Funded Behavioral Health Providers.
NOTE: This change applies only to NC Medicaid Direct beneficiaries. There is no impact to beneficiaries enrolled in NC Medicaid Managed Care.OverviewThe North Carolina Department of Health and Human Services (NCDHHS) is transitioning Pharmacy Benefit Administrator (PBA) services for NC Medicaid Direct. Beginning May 2, 2026, Prime Therapeutics State Government Solutions LLC (Prime) will serve as the PBA for NC Medicaid Direct pharmacy claims.
Flexibilities extended through Feb. 6, 2026, for NC Medicaid beneficiaries due to additional Winter Storm weather.
Flexibility extended to Jan. 30, 2026, for NC Medicaid beneficiaries due to Winter Storm.
Assessment rates were affected by the implementation and subsequent reversal of the Oct. 1, 2025, per diem rate reductions.
Flexibilities effective Jan. 23, 2026, to Jan. 26, 2026, for NC Medicaid beneficiaries due to Winter Storm.
Promulgation of New Clinical Coverage Policies and Amendment to Clinical Coverage Policy 8A Enhanced Mental Health and Substance Abuse Services.
Effective Jan. 1, 2026, The Acute Inpatient Hospital Services policy has been revised.
Coverage for Healthcare Common Procedure Coding System Code G0512 is end-dating effective Dec. 31, 2025.