The North Carolina Current Operations Appropriations Act of 2021 (Session Law 2021-180) enacted legislation to allow charter schools, as Local Education Agencies (LEAs), to participate in North Carolina Medicaid reimbursement. Specifically, North Carolina General Statute §115C-218.105 is amended to allow for charter schools approved by the State as a public school to be deemed a local government entity solely with respect to the North Carolina Medicaid program.
The North Carolina Medicaid program currently allows for reimbursement to enrolled LEAs as governmental entities in three areas:
- claims payment for NC Medicaid Direct covered services,
- an annual Medicaid cost-settlement, and
- reimbursement of select eligible Medicaid administrative costs.
NC Medicaid Direct covered services are defined as reimbursable under NC Medicaid Clinical Coverage Policy 10C on the Specialized Therapies Clinical Coverage Policies web page.
The NC Medicaid cost reporting and settlement process for Medicaid services provided in schools is defined in the North Carolina State Plan, Attachment 4.19-B, Section 6, found at the bottom of the Medicaid State Plan Public Notices web page.
Medicaid Administrative Claim (MAC) payments are retrospective quarterly payments to eligible LEAs meeting certain federal and state requirements for school-based administrative claiming. Following NC Medicaid enrollment as a Medicaid LEA provider, charter schools should reach out to the Division of Health Benefits for additional information at Medicaid.LEACostReports@dhhs.nc.gov.
To begin this process, eligible charter schools will be required to obtain an NPI number and enroll in Medicaid through the secure provider portal, NCTracks.
Charter schools will enroll under taxonomy code 251300000X. Available taxonomies and criteria are outlined in the Provider Permission Matrix on NCTracks. The Medicaid provider enrollment application and FAQs can be found on the Getting Started With Enrollment web page of NCTracks. Provider User Guides and Fact sheets are also available on NCTracks.
Contact
NCTracks Call Center: 800-688-6696