Topics Related to Medicaid Managed Care

Updates to NC Medicaid Temporary Flexibilities Due to Additional Winter Storm

Flexibilities extended through Feb. 6, 2026, for NC Medicaid beneficiaries due to additional Winter Storm weather.

Extended NC Medicaid Temporary Flexibility Due to January Winter Storm

Flexibility extended to Jan. 30, 2026, for NC Medicaid beneficiaries due to Winter Storm.

Skilled Nursing Facility Provider Assessment Updates

Assessment rates were affected by the implementation and subsequent reversal of the Oct. 1, 2025, per diem rate reductions.

NC Medicaid Temporary Flexibilities Due to Expected January Winter Storm

Flexibilities effective Jan. 23, 2026, to Jan. 26, 2026, for NC Medicaid beneficiaries due to Winter Storm.

Behavioral Health Clinical Coverage Policy Updates

Promulgation of New Clinical Coverage Policies and Amendment to Clinical Coverage Policy 8A Enhanced Mental Health and Substance Abuse Services.

2A-1 Acute Inpatient Hospital Services Policy Update

Effective Jan. 1, 2026, The Acute Inpatient Hospital Services policy has been revised.

Updated Coverage for Psychiatric Collaborative Care Management – December 30, 2025

Coverage for Healthcare Common Procedure Coding System Code G0512 is end-dating effective Dec. 31, 2025.

Updates to Clinical Coverage Policy 1S-11: Genetic Testing Gene Expression

Clinical Coverage Policy 1S-11 will include coverage for AlloMap® effective Jan. 1, 2026.

Medicaid Rate Reduction Reversal Update

This bulletin applies to NC Medicaid Direct and NC Medicaid Managed Care.

NC Medicaid to Reinstitute Coverage of GLP-1s for Weight Management

Effective Dec. 12, 2025, coverage for GLP-1s for the treatment of obesity will be reverted to the coverage available as of Sept. 30, 2025.