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.

Medicaid Expansion

Medicaid Expansion Alternative Benefit Plan State Amendment

This alternative plan outlines the benefits available to the Medicaid Expansion eligibility group. North Carolina is proposing to provide all individuals who are eligible for expansion with the same benefits provided to current Medicaid beneficiaries.

Review the State Plan Amendment regarding an Alternative Benefit Plan for a New Medicaid Expansion Eligibility Group here

Alternative Benefit Plan documents are listed below:

Waivers

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

Print application selector for 1915(b) Waiver: NC.0002.R05.02

NC.1326.R01.02 - (b)(c) Concurrent TBI Amendment Approval Letter

NC.0423.R03.10 - (b)(c) Concurrent Innovations Amendment Approval Letter

Application for 1915(c) HCBS Waiver: NC.0423.R03.10

NC.0423.R03.10 - (b)(c) Concurrent Innovations Amendment Approval Letter

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

Application for 1915(c) HCBS Waiver: NC.1326.R01.02

NC.1326.R01.02 - (b)(c) Concurrent TBI Amendment Approval Letter

Draft-1915C HCBS Innovations Waiver Renewal, July 1, 2024

The NC 1915(c) Home and Community Based Services Innovations Waiver current 5-year cycle period will expire on June 30, 2024. NC Medicaid’s goal is to renew the waiver with an effective date of July 1, 2024, for continuity of program planning.

A webinar is planned for Feb. 29, 2024 to provide information about the renewal project plan. The draft application for 1915(c) NC Innovations Waiver is posted for a 30-day public comment period. The public comment period is from Feb. 9, 2024 through March 12, 2024. The Waiver can be accessed at the following link: Draft Application for 1915(c) HCBS Waiver_NC.025.04.00

Comments can be submitted to Medicaid.WaiverComment@dhhs.nc.gov. Written comments may be sent to the following address (please indicate “NC Medicaid HCBS 1915(c) Innovations Waiver” in the written message):

North Carolina Department of Health and Human Services 
NC Medicaid HCBS 1915(c) Innovations Waiver Team 
1950 Mail Service Center Raleigh, NC 27699-1950

Please share this notice with those in your organization and externally as needed. Thank you in advance for your review of this draft Waiver. 

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.

Community Alternatives Program for Children Waiver Renewal

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

2024 Ten-Day Posting for Submission to the Centers for Medicare and Medicaid Services (CMS) 

  • More coming soon.

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

2024 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 02/27/2024