Topics Related to Medicaid Direct

Coverage has been restored to definitive drug testing codes that exceed seven drug classes retroactive to Dec. 1, 2024.
Use Standard Plan and Tailored Plan provider portals or Real-Time Eligibility Electronic Data Interchange Transactions 270/271.

An amended version of Clinical Coverage Policy 5A-3, Nursing Equipment and Supplies with an effective date of March 1, 2025, was posted to the NC Medicaid Clinical Coverage Policy web page.

This bulletin describes the changes required under CAA 5121 as well as reminders on the suspension of benefits during incarceration.
Effective Date: April 1, 2025.
The PREP Act is extended to Dec. 31, 2029, expanding COVID-19 and flu vaccine access at pharmacy Point-of-Sale for ages 3 and older.
Effective Feb. 3, 2025, unless communicated otherwise by the Department
Providers affected by Hurricane Helene have additional time to submit requests for services
NC Medicaid updates mental health and substance use disorder policies.