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.
Alternative Benefit Plan documents are listed below:
- ABP1 Populations
- ABP2 Voluntary Benefit Package Selection Assurances
- ABP3 Selection of Benchmark Benefit Package
- ABP4 Alternative Benefit Plan Cost-Sharing
- ABP5 Benefits Description
- ABP7 Benefits Assurances
- ABP8 Service Delivery Systems
- ABP10 General Assurances
- ABP11 Payment Methodology
Waivers
Draft NC 1915(b) Waiver Renewal - 042.06.00 - Jan 1, 2025
The draft application for NC 1915(b) Waiver Renewal is posted for public comments. The Waiver can be accessed on the NC Medicaid State Plan Public Notices webpage. Comments can be submitted to Medicaid.WaiverComment@dhhs.nc.gov. Written comments may be sent to the following address (please indicate “NC Medicaid 1915(b) Waiver Renewal” in the written message):
North Carolina Department of Health and Human Services
NC Medicaid 1915b 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.
1915(c) NC TBI Waiver Application March 1, 2024 Waiver Amendment Update
1915(c) TBI Waiver Amendment, Waiver Approved March 1, 2024
Draft-1915(c) HCBS Innovations Waiver Application March 1, 2024 Amendment Update
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.
Webinars were held on Feb. 29 and March 6, 2024 to provide information about the renewal project plan. The draft application for 1915(c) NC Innovations Waiver was posted for a 30-day public comment period. The public comment period was from Feb. 9, 2024 through March 12, 2024. The Waiver can be accessed at the following link: 1915(c) Innovations Waiver Amendment, Waiver Approved March 1, 2024
NC Innovations Renewal Public Hearing
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
- 1915(c) HCBS Waiver: NC.4141.R07.01 Final Waiver
- 1915(c) Community Alternatives Program for Children (CAP/C) Waiver - NC.4141.R07.01 Approval Letter
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
- 2025 Proposed Public Notices
- 2024 Proposed Public Notices
- 2023 Proposed Public Notices
- 2022 Proposed Public Notices
- 2021 Proposed Public Notices
- 2020 Proposed Public Notices
- 2019 Proposed Public Notices
- 2018 Proposed Public Notices
- 2017 Proposed Public Notices
- 2016 Proposed Public Notices
- 2015 Proposed Public Notices
- 2014 Proposed Public Notices
- 2013 Proposed Public Notices
2025 Ten-Day Posting for Submission to the Centers for Medicare and Medicaid Services (CMS)
- SPA 25-0002 10-Day Public Notice (Termination of ADATC)
- SPA 25-0003 10-Day Public Notice (1915(i) Parity)
2024 Ten-Day Posting for Submission to the Centers for Medicare and Medicaid Services (CMS)
- SPA 24-0036 10-Day Public Notice (Ambulance)
- SPA 24-0037 10-Day Public Notice (Hospital Transfer Outlier)
Previous Ten-Day Posting for Submission to the Centers for Medicare and Medicaid Services (CMS)
- 2024 Ten-Day Postings for Submission to CMS
- 2023 Ten-Day Postings for Submission to CMS
- 2022 Ten-Day Posting for Submission to CMS
- 2021 Ten-Day Posting for Submission to CMS
2024 Proposed Amendments Sent to CMS
- SPA 24-0001 Proposed Amendment Sent to CMS (Assertive Community Treatment)
- SPA 24-0002 Proposed Amendment Sent to CMS ( Behavioral Health Long-Term Residential)
- SPA 24-0003 Proposed Amendment Sent to CMS (Community Support Team)
- SPA 24-0004 Proposed Amendment Sent to CMS (Crisis Services)
- SPA 24-0005 Proposed Amendment Sent to CMS (Intensive In-Home Services)
- SPA 24-0006 Proposed Amendment to CMS (Multi-Systemic Therapy)
- SPA 24-0007 proposed Amendment Sent to CMS (Outpatient Behavioral Health - Psychiatry)
- SPA 24-0008 Proposed Amendment Sent to CMS (Outpatient Behavioral Health - Psychotherapy)
- SPA 24-0009 Proposed Amendment Sent to CMS (Partial Hospitalization Day Treatment)
- SPA 24-0010 Proposed Amendment Sent to CMS (Peer Support)
- SPA 24-0011 Proposed Amendment Sent to CMS (Psychosocial Rehabilitation)
- SPA 24-0012 Proposed Amendment Sent to CMS (Physician Administered Drug Program (PADP))
- SPA 24-0013 Proposed Amendment Sent to CMS (Single State Agency FFM Determination)
- SPA 24-0014 Proposed Amendment Sent to CMS (Tailored Care Management (TCM)
- SPA 24-0015 Proposed Amendment Sent to CMS (Third-Party Liability Payers Rules)
- SPA 24-0016 Proposed Amendment sent to CMS (Substance Abuse Comprehensive Outpatient Treatment (SACOT)
- SPA 24-0017 Proposed Amendment sent to CMS (Substance Abuse Intensive OP Program (SAIOP)
- SPA 24-0018 Proposed Amendment Sent to CMS (1915i)
- SPA 24-0019 Proposed Amendment Sent to CMS (Opioid Antagonist Co-Pay Removal)
- SPA 24-0020 Proposed Amendment Sent to CMS (Clinically Managed Low-Intensity Residential)
- SPA 24-0021 Proposed Amendment Sent to CMS (Clinically Managed Population Specific High Intensity)
- SPA 24-0023-Medically Monitored Intensive Inpatient Services
- SPA 24-0024 Proposed Amendment Sent to CMS (Independent Practitioner Providers (IPPs) Treating Adult Beneficiaries)
- SPA 24-0025 Proposed Amendment Sent to CMS (Coverage of Imported Prescribed Drugs)
- SPA 24-0026 Proposed Amendment sent to CMS (Physician Services - Eligible Medical Professionals)
- SPA 24-0027 Proposed Amendment sent to CMS (Graduate Medical Education (GME)
- SPA 24-0028 Proposed Amendment to CMS
- SPA 24-0031 Proposed Amendments to CMS
- SPA 24-0032 Proposed Amendment Sent to CMS (Coverage of FDA-Approved Weight Loss Drugs)
- SPA 24-0033 Proposed Amendment sent to CMS (1915i - Income Disregard)
- SPA 24-0034 (Ambulatory Withdrawal Management without Extended On-Site Monitoring)
- SPA 24-0035 (Ambulatory Withdrawal Management with Extended On-Site Monitoring)
Proposed Amendments Sent to CMS
- 2023 Proposed Amendments Sent to CMS
- 2022 Proposed Amendments Sent to CMS
- 2021 Proposed Amendments Sent to CMS
- 2020 Proposed Amendments Sent to CMS
- 2019 Proposed Amendments Sent to CMS
- 2018 Proposed Amendments Sent to CMS
- 2017 Proposed Amendments Sent to CMS
- 2016 Proposed Amendments Sent to CMS
- 2015 Proposed Amendments Sent to CMS
- 2014 Proposed Amendments Sent to CMS
- 2013 Proposed Amendments Sent to CMS
Modified Adjusted Gross Income (MAGI)
2015 State Plan Amendment - MAGI
Updates
- 2022 Updates
- 2021 Updates
- 2020 Updates
- 2019 Updates
- 2018 Updates
- 2017 Updates
- 2016 Updates
- 2015 Updates
- 2014 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 12/04/2024