Transition of Care
The North Carolina Department of Health and Human Services (NCDHHS) developed policies and procedures for Transition of Care to support beneficiaries who transition between NC Medicaid Direct and NC Medicaid Managed Care delivery systems. The Transition of Care is designed to maintain continuity of care for each beneficiary and minimize the burden on providers during transition.
Along with the established Transition of Care policy, the Department has established technology and process requirements for all stakeholders to support the Transition of Care design.
Updates
Transition of Care Policy
Consistent with federal requirements and NC Medicaid’s vision to ensure continuity of care for members transitioning between prepaid health plans (PHPs) or service delivery systems, NC Medicaid has released the NCDHHS Transition of Care Policy. The draft policy was released for public comment in February 2020 and finalized on Feb. 25, 2021. The latest version, effective Dec. 1, 2025 is published below:
- Transition of Care Policy - Version 2.0, Effective Dec. 1, 2025
Transition of Care Policy Previous Versions
- NCDHHS Transition of Care Policy - Version 1.5, April 2023
- Política de transición de la atención médica - versión en Español
Forms for Transition of Care
- Transition of Care Warm Handoff Summary
- Transition of Care Warm Handoff Summary (Spanish)
- For questions about the Transition of Care Policy, please email Medicaid.NCEngagement@dhhs.nc.gov.
Transition of Care Disenrollment Protocols
- TOC Protocol between Standard Plan Health Plans and LME MCOs
- TOC Protocol Disenrollment due to Dual Eligibility
- TOC Protocol Disenrollment due to Extend NF Stay
- TOC Protocol Disenrollment Due to Foster Care Enrollment
Resources
Previous Webinars
February 2, 2023 webinar: Transition of Care Overview for Local Health Departments