This bulletin applies to NC Medicaid Managed Care.
Since the launch of the NC Medicaid Managed Care Standard Plan, the North Carolina Department of Health and Human Services (NCDHHS) has gathered valuable insights from Medicaid beneficiaries, providers, health systems, health plans and other partners, and has learned meaningful lessons in administering a Medicaid program under managed care.
The paper, Improving Member Health Through Managed Care Program Enhancements: North Carolina’s Approach to Standard Plan Re-Procurement, describes key policy priorities that will build on progress achieved over the last several years while strengthening areas offering opportunities for advancement or requiring additional attention and support. NCDHHS seeks public feedback on this paper by May 7, 2025. Please see the bottom of this bulletin for how to submit comments.
A summary of this paper is available on the NC Medicaid Policy Papers webpage.
Key Objectives
NC Medicaid’s vision is to improve the health of North Carolinians through an innovative, whole-person centered, and well-coordinated system of care, which addresses both medical and non-medical drivers of health. A key area of focus in this procurement cycle will be that NCDHHS expects health plans and managed care partners will bring innovation to help NCDHHS slow cost growth of the program – not by restricting access or through greater administrative burdens but by decreasing avoidable or potentially avoidable care. Therefore, as Medicaid managed care continues to mature in North Carolina, NCDHHS seeks to leverage Standard Plans in more innovative, effective, and efficient ways to improve health guided by the following key objectives:
- Provide members with timely access to care, a positive and respectful experience, and improved health outcomes
- Advance high-value and efficient care through collaborative care delivery that addresses the full spectrum of member needs and improves population health
- Engage and support providers and the healthcare workforce while reducing provider administrative burden
- Support cost effectiveness and predictability for long-term program sustainability
The program changes for NC Medicaid Managed Care Standard Plans were identified for their potential to improve the member and provider experience, enhance care management and ensure timely access to high-value care. NCDHHS is dedicated to improving the health of all North Carolinians.
Next Steps and Request for Feedback
NCDHHS invites comments from Medicaid members, providers, community-based organizations, health plans, state and local officials, and other partners to ensure that these objectives reflect the needs and values of the people served by Medicaid. Sustaining the current Medicaid program and making certain changes will require statutory authority and budget support from the North Carolina General Assembly, and NCDHHS is committed to collaboration with lawmakers.
Feedback on the Improving Member Health Through Managed Care Program Enhancements policy paper is welcome. Please send written input by May 7, 2025, to:
Email: Medicaid.NCEngagement@dhhs.nc.gov with the subject line “Managed Care Program Enhancements Feedback”
U.S. Mail: Department of Health and Human Services, Division of Health Benefits, 1950 Mail Service Center, Raleigh NC 27699-1950
Drop-off: Department of Health and Human Services, Dorothea Dix Campus, Adams Building, 101 Blair Dr., Raleigh NC
Send questions about NC Medicaid transformation to Medicaid.NCEngagement@dhhs.nc.gov. For more information about transformation efforts, visit NC Medicaid's Transformation website page.