Medicaid State Plan Public Notices

Title XIX of the Social Security Act requires that North Carolina provide a plan to administer and manage the North Carolina Medicaid Program. The North Carolina Medicaid State Plan outlines the organization and function of the Division of Health Benefits. It provides amount, scope and duration of services, as well as eligibility requirements.

Waivers

1915(b) Mental Health, Intellectual/Developmental Disability (IDD) and Substance Use Disorder (SUD) Waiver Amendment for Tailored Plan Launch

A draft application for § 1915 (b) Mental Health/IDD/SUD waiver is posted for a 30-day public comment period. The public comment period is from Nov. 9, 2022, through Dec. 8, 2022. This amendment is to remove populations who will be in Tailored Plans and to add 1915(i) waiver services. Submit your comment via email to Medicaid.WaiverComment@dhhs.nc.gov.

1915(b) Mental Health/IDD/SUD Waiver Amendment Draft

1915(C) NC Innovations Waiver Amendment for Tailored Plan Launch

A draft application for § 1915 (c) NC Innovations waiver is posted for a 30-day public comment period. The public comment period is from November 17, 2022, through December 18, 2022. The Purpose of this Waiver Amendment is to align with Medicaid Transformation and the Tailored Plan Launch. Submit your comment via email to Medicaid.WaiverComment@dhhs.nc.gov.

1915(C) NC Innovations Waiver Amendment

1915(C) NC TBI Waiver Amendment for Tailored Plan Launch

A draft application for § 1915 (c) NC TBI waiver is posted for a 30-day public comment period. The public comment period is from November 17 through December 18, 2022. The Purpose of this Waiver Amendment is to align with Medicaid Transformation and the Tailored Plan Launch. Submit your comment via email to Medicaid.WaiverComment@dhhs.nc.gov.

1915(C) NC TBI Waiver Amendment

Community Alternatives Program for Disabled Adults Renewal Waiver Application Update

Community Alternatives Program for Disabled Adults Approved Waiver 

For more information, please visit the CAP/DA webpage.

Traumatic Brain Injury Waiver Application Update

A draft application for § 1915 (c) Home and Community-Based Services (HCBS) Traumatic Brain Injury Waiver is posted for a 30-day public comment period. The public comment period is from January 27-February 26, 2021. The currently approved TBI Waiver waiver with an effective date of May 1, 2018 will continue to operate at the levels that are previously approved. Submit your comment via email to Medicaid.WaiverComment@dhhs.nc.gov.

TBI Waiver and Public Comment

Community Alternatives Program for Children Waiver Renewal

Proposed CAP/C Waiver renewal posted for public comment on Aug. 12, 2022.

This announces the 30-day public comment period to review the proposed Community Alternatives Program for Children (CAP/C) § 1915 Home- and Community-based Services (HCBS) waiver application. NC Medicaid announced the renewal of the CAP/C waiver in September 2020.

An agreement between the State waiver administrating agency (NC Medicaid) and the Centers for Medicare and Medicaid Services (CMS) must be reached to implement the proposed changes statewide. If substantial changes to the items in the crosswalk below, an announcement will be made. 

  • The proposed waiver application will be posted for 30 days. 
  • Upon submission of the waiver application, CMS has 90 days to approve the waiver. 
  • CMS may need additional time after the 90-day approval period has expired due to recommendations for substantial changes to specific sections in the renewal application. 

A crosswalk of the proposed changes in the waiver application is listed below: 

The 30-day public comment period is your opportunity to provide feedback to the proposed changes. Your comments and feedback are welcome. Instructions to where to send your comments and feedback are listed below. 

Oral comment and feedback, dial 919-855-4345 and leave a message. 

A return response to comments or feedback will not be immediately provided. After the 30-day public posting, all comments and feedback will be compiled to include resolution of comments. The compilation of the public comments will be posted to the CAP/C webpage.    

Contact: LTSS, Medicaid.capda@dhhs.nc.gov

Access Monitoring Review Plan

In 2015, the Centers for Medicare and Medicaid Services (CMS) established regulations (42 CFR § 447.203) for states to document whether Medicaid payments are sufficient to enlist providers to assure beneficiary access to covered services. These regulations require states to develop and submit an access monitoring review plan (AMRP or Plan), every three years, for selected service categories. The Plan must present an access monitoring analysis including data sources, methodologies, baselines and assumptions. 2016-2018 Access Monitoring Review Plan (AMHRP) 

Proposed Public Notices for State Plans

2023 Ten-Day Posting for Submission to the Centers for Medicare and Medicaid Services (CMS) 

Previous Ten-Day Posting for Submission to the Centers for Medicare and Medicaid Services (CMS) 

2023 Proposed Amendments Sent to CMS

Proposed Amendments Sent to CMS

Modified Adjusted Gross Income (MAGI)

2015 State Plan Amendment - MAGI

Updates

Medicaid State Plan

State Plan under Title XIX of the Social Security Act Medical Assistance Program

NC Health Choice State Plan

Child Health Plan under Title XXI of the Social Security Act Children's Health Insurance Program

This page was last modified on 02/03/2023