Children and Family Specialties Plan Policy Flexibilities to End June 30, 2026

With the launch of the Children and Family Specialties Plan (CFSP), NC Medicaid enacted policy levers to promote continuity of care for CFSP members and ease the administrative burden on providers. For more information, see the Provider Bulletin from Oct. 13, 2025.

The following policies will expire June 30, 2026. These include:

• Relaxed medical prior authorization (PA) requirements
• Relaxed pharmacy PA requirements
• Non-participating providers paid at participating provider rates
• Ability for beneficiaries to change their primary care provider (PCP) for any reason
• Continuity of care for an ongoing course of treatment

Effective July 1, 2026, standard CFSP policies, authorization, reimbursement and network requirements will apply unless otherwise specified by the Department.

Please note the non-participating providers follow in-network prior authorization flexibility is set to expire Oct. 31, 2026.

Contact

For questions regarding the Children and Family Specialties Plan flexibilities, contact Healthy Blue Care Together Provider Support at 833-777-3698 or nc.provider@healthbluenc.com.