This fall, care managers, caregivers and providers supporting high‑risk Medicaid beneficiaries are invited to join a three‑part webinar series focused on preparing for, responding to and recovering from extreme weather events.
Topics Related to Primary Care Providers
Care Management rate considerations effective July 1, 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:
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.
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.
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.
Includes medical and pharmacy prior authorizations, out-of-network provider rates and rules and primary care provider changes.
The program is seeking current Medicaid providers to become early adopters of two new use cases of the state-designated health information exchange.
Feedback Requested on Proposed Approach.
To reduce the provider administrative burden during the enrollment application process, an important update has been made.