This bulletin applies to NC Medicaid Direct and NC Managed Care.
As part of the NC Medicaid program, Local Health Departments (LHDs) provide care management services to at-risk children (0 to 5 years) and high-risk pregnant women (ages 14 through 44) through the Targeted Case Management Medicaid State Plan service. These services are referred to as Care Management for At-Risk Children (CMARC) and Care Management for High-Risk Pregnancies (CMHRP). At the start of North Carolina’s transition to NC Medicaid Managed Care on July 1, 2021, NC Medicaid implemented care coordination and management into managed care contracts serving the majority of NC Medicaid beneficiaries.
To facilitate continued beneficiary access to CMARC and CMHRP through December 31, 2026, NC Medicaid is working with the Prepaid Health Plans to maintain CMARC and CMHRP Per Member Per Month (PMPM) payments to LHDs for serving these populations through Dec. 31, 2026.
Providers should continue to refer eligible high-risk pregnant women and at-risk children to LHDs for CMARC and CMHRP through Dec. 31, 2026. The Department will be releasing future bulletins with information regarding the approach to care management for these populations.
Technology Support and Payment Structure Extended Through Dec. 31, 2026
The technology platform used by LHDs to record care management activities and track member progress will remain available to LHDs and funded by the Department through Dec. 31, 2026.
NC Medicaid is working closely with the Prepaid Health Plans to maintain robust care coordination and management services for beneficiaries qualifying for at-risk child or high-risk pregnancy care management services.
Contact
Email medicaid.cmhrp.cmarc@dhhs.nc.gov with questions related to this Medicaid Bulletin.