Topics Related to Medicaid Managed Care

Hospital at Home Program Re-Launching for NC Medicaid

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.

REMINDER: Electronic Visit Verification (EVV) Home Health Implementation Hard Launch Effective Oct. 1, 2023

Claims without the required EVV data will be denied.

NC Managed Care Capitation Rates – Updated Care Management Assumptions

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.

Updated: NC Medicaid Temporary Flexibilities Due to Hurricane Idalia

This bulletin replaces NC Medicaid Temporary Flexibilities Due to Hurricane Idalia published on Aug. 30, 2023, to correct the end date.

NC Medicaid Temporary Flexibilities Due to Hurricane Idalia

Provider guidance for reimbursement, enrollment and providing care for Medicaid beneficiaries

NC Medicaid Managed Care Provider Update – August 22, 2023

Includes provider recredentialing/reverification, Medicaid expansion, Tailored Plan implementation and more.

Specialty Care Referrals in NC Medicaid Reminder: NC Medicaid does not require referrals for specialty care.

This bulletin provides information about referrals for specialty care for NC Medicaid beneficiaries.

CMS Approves New Flexibilities for the NC Medicaid Reform Section 1115 Demonstration Project

Includes flexibilities related to Tailored Plans and Healthy Opportunities Pilots

NC Medicaid Planning for October 1 Medicaid Expansion Launch

With state budget negotiations ongoing, NCDHHS has worked with CMS to negotiate a compromise to begin submitting documents needed for federal approval to launch Medicaid expansion on October 1, 2023.

NC Medicaid Managed Care Provider Update – July 20, 2023

Includes provider recredentialing/reverification, billing requirement modifications, Tailored Plan implementation, upcoming key milestones, playbook updates and more.