Topics Related to Primary Care Providers

Children and Family Specialties Plan Policy Flexibilities to End June 30, 2026

With the launch of the Children and Family Specialties Plan (CFSP), NC Medicaid enacted policy levers to promote continuity of care for CFSP members and ease the administrative burden on providers. For more information, see the Provider Bulletin from Oct. 13, 2025.

The following policies will expire June 30, 2026. These include:

NC Medicaid Update on the Care Management for At-Risk Children and Care Management for High-Risk Pregnancy Programs

Local Health Departments will continue to offer Care Management for At Risk Children and Care Management for High-Risk Pregnancy services to Medicaid beneficiaries, with Per Member Per Month payments remaining in effect, both through Dec. 31, 2026.

Value-Based Payment Update: AMH Standardized Performance Incentive Program

Following stakeholder engagement and review of departmental priorities, NC Medicaid will not be implementing the Advanced Medical Home (AMH) Standardized Performance Incentive Program (SPIP) at this time.

Update on NC Medicaid Rate Reductions - Dec. 10, 2025

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.

Flexibilities to Ensure Continuity of Care and Ease Provider Administrative Burden at Children and Families Specialty Plan Launch

Includes medical and pharmacy prior authorizations, out-of-network provider rates and rules and primary care provider changes.

Health Information Exchange Medicaid Services Early Adopters Program is Live

The program is seeking current Medicaid providers to become early adopters of two new use cases of the state-designated health information exchange.

Value-Based Payment Update: AMH Standardized Performance Incentive Program Draft Policy Guide

Feedback Requested on Proposed Approach.

Education Transcripts No Longer Required for North Carolina Medical Board Licensed Providers

To reduce the provider administrative burden during the enrollment application process, an important update has been made.

Ensuring Continuity of Care Through Tailored Plan Launch

Reminders for NC Medicaid Providers related to transitions at Tailored Plan Launch.

Flexibilities to Ease Provider Administrative Burden at Tailored Plan Launch

Includes medical and pharmacy prior authorizations, out of network provider rates and rules, and primary care provider changes