North Carolina Governor Josh Stein issued Executive Order No. 31 on Jan. 21, 2026, declaring a State of Emergency in anticipation of the severe winter storm expected to impact the state beginning on or around Jan. 24, 2026. The storm is forecasted to cause significant impacts across North Carolina.
NC Medicaid is committed to North Carolina's response to this upcoming storm. We are working with county and federal partners to make it faster and easier for beneficiaries to receive — and for health care professionals to provide — Medicaid care and services.
This bulletin describes flexibilities effective Jan. 23, 2026, to Jan. 26, 2026 (unless otherwise communicated by the North Carolina Department of Health and Human Services (NCDHHS)), for the NC Medicaid program including NC Medicaid Direct and NC Medicaid Managed Care, as indicated below. Updates will be provided as they become available.
Flexibility for both NC Medicaid Direct and NC Medicaid Managed Care
Early Prescription Refills during Governor’s State of Emergency Declaration
The potential for severe weather conditions may present situations where NC Medicaid beneficiaries in impacted areas may require an early refill of their medications. NC Medicaid enrolled pharmacy providers have been approved to fill these prescriptions early, following applicable co-pay requirements.
Effective Jan. 23, 2026, to Jan. 26, 2026 (unless otherwise communicated by NCDHHS), the early refill is being allowed to ensure that all Medicaid beneficiaries have access to necessary medications.
For NC Medicaid Direct
NC Medicaid enrolled pharmacy providers should resubmit these claims with “09” (Emergency Preparedness) in the Prior Authorization (PA) Type Code field to override a denial for an early refill. Do not place any values in the Submission Clarification Code field.
This allows the beneficiaries to receive their medication during an emergency without using either of their limited-use Submission Clarification Code overrides. Additional questions can be directed to the NCTracks service line (800-688-6696).
For NC Medicaid Managed Care
Providers should contact the pharmacy service line (numbers below) to confirm if additional documentation or processes need to be completed to allow for emergency prescription refills during this State of Emergency.
Standard Plans
- AmeriHealth: 866-885-1406
- Healthy Blue: 833-434-1212
- Carolina Complete: 833-750-4461
- United Healthcare: 855-258-1593
- Wellcare: 866-799-5318
Tailored Plans
- Alliance Health: 855-759-9300
- Partners: 866-453-7196
- Trillium: 866-245-4954
- Vaya Health: 800-540-6083
Children and Families Specialty Plan: 833-777-3788
Reminder for NC Medicaid Direct Only
Community Alternatives Program for Children and Community Alternatives Program for Disabled Adults
A critical role for case management entities serving the Community Alternatives Program for Children (CAP/C) and Community Alternatives Program for Disabled Adults (CAP/DA) beneficiaries is to provide support to ensure the health, safety and well-being of all CAP beneficiaries in the preparation for, during and immediately after a severe weather event. To fulfill this requirement, CAP case management entities are directed to assist their assigned CAP beneficiaries in activating their emergency and disaster plans in preparation for the unknown impact of the winter storm.
When helping CAP beneficiaries activate their plans, it is imperative to emphasize checking and updating severe weather kits. Ready NC is a valuable resource to use for additional information and assistance to prepare for the winter storm. CAP case management entities should encourage beneficiaries to register with the special needs registry in their county.
Please coordinate with local county emergency management departments if assistance is needed.
Per the CAP/C and CAP/DA waiver, case management entities should complete an assessment of the health and well-being status of each CAP beneficiary in the eCAP system for the CAP beneficiaries they serve. Below is the information that must be included in the Disaster Wellness report.
- Name of contact person for questions regarding the report
- Status of beneficiary (safe, sustained impact, unknown)
- Beneficiary current location (home, shelter, facility, relative – in/out of county/state)
- Beneficiary contact information, if displaced from home
- Documentation if the current service plan meets the needs of the beneficiary as a result of the winter storm
- If it does not, specify what additional or replacement services are needed through a plan revision.
Contact
To seek technical assistance in managing a waiver beneficiary’s recovery from the winter storm, contact the CAP unit at medicaid.capc@dhhs.nc.gov or medicaid.capda@dhhs.nc.gov.