Topics Related to Medicaid Managed Care

This bulletin provides updates on NC Medicaid programs that received legislative increases to service rates in the Current Operations Appropriations Act of 2023 (SL 2023-134).
Providers should submit claims for dates of service that now fall in NC Medicaid Direct.
Effective Nov. 1, 2023, NC Medicaid will remove all copay requirements for antiretroviral medications which decrease viral load in patients with HIV.
Includes provider recredentialing/reverification, Medicaid expansion, Tailored Plan implementation and more.
Hospital at Home Program Re-Launch: NC Medicaid will cover the Acute Hospital at Home Program starting Nov. 1, 2023.

NOTE: This Bulletin was revised on April 2, 2024 to correct an error. In the original version, published Sept. 27, 2023, it was stated that the Hospital at Home Program had a previous end date of March 31, 2021. Prior to relaunch, the previous end date was March 31, 2022, as corrected and explained below.
Claims without the required EVV data will be denied.
The North Carolina Department of Health and Human Services (the Department) is releasing updated information about the assumptions underlying the care management component of capitation payments to NC Medicaid Managed Care Prepaid Health Plan (PHPs) Standard Plans. The PHP Standard Plan capitation rates developed by the Department reflect its belief that investment in robust community-based care management will drive improvements in care outcomes and achieve greater value from the state’s Medicaid dollar.
This bulletin replaces NC Medicaid Temporary Flexibilities Due to Hurricane Idalia published on Aug. 30, 2023, to correct the end date.
Provider guidance for reimbursement, enrollment and providing care for Medicaid beneficiaries
Includes provider recredentialing/reverification, Medicaid expansion, Tailored Plan implementation and more.