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

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

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

2024 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) 

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

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This page was last modified on 12/19/2024