The Centers for Medicare & Medicaid Services (CMS) requires all states contracting with Medicaid Managed Care plans to develop and submit a quality strategy on a three-year cycle. The 2025 NC Medicaid Managed Care Quality Strategy is a roadmap through which the state articulates its vision and goals in the NC Medicaid Managed Care program. States must review and update their quality strategy at least every three years or whenever there have been significant changes in the state’s Medicaid program.
The North Carolina Department of Health and Human Services (NCDHHS) has finalized the 2025 NC Medicaid Managed Care Quality Strategy (NC Quality Strategy) and received approved from CMS. NCDHHS published the 2025 NC Quality Strategy on the NC Medicaid Quality Management and Improvement web page.
The 2025 NC Quality Strategy includes the following key changes from the 2023 Quality Strategy:
- Updated the managed care implementation timelines;
- Updated the language related to Tailored Plans and the Children and Families Specialty Plan (CFSP) 42 CFR 438.340;
- Included information related to Medicaid expansion population;
- Updated relevant quality measure sets; and
- Included benchmarks for the quality measures that can evaluate how NCDHHS is progressing toward the Medicaid program Quality Strategy goals
Contact
NC Medicaid Quality Team medicaid.quality@dhhs.nc.gov