This bulletin applies to NC Medicaid Direct and NC Medicaid Managed Care.
Topics Related to Medicaid Managed Care
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.
This announcement is for NC Medicaid and Division of Mental Health, Developmental Disabilities, and Substance Use Services State Funded Behavioral Health Providers.
The new NC Medicaid Mental Health Parity website provides information on NC Medicaid compliance with federal mental health parity requirements.
NC Medicaid is providing updated information to providers about the federal prohibitions on certain providers.
Recent court rulings now require the North Carolina Department of Health and Human Services to reverse provider rate reductions and restore rates to their Sept. 30, 2025, levels.
NC Medicaid Managed Care plans may apply utilization edits and/or prior authorization criteria per the Food and Drug Administration label on drugs when the State has not established criteria and has not prohibited use of criteria.
NC Medicaid is providing updated information to providers about the federal prohibitions on certain providers.
Request to Move forms for members in the Children and Families Specialty Plan to move to a Behavioral Health I/DD Tailored Plan do not need to complete a Service-associated Request.
This guidance is based on the NC Immunization Program/Vaccines for Children guidelines.