NC Section 1115 Demonstration Waiver

North Carolina is seeking to renew its Medicaid Reform Demonstration for another five-year period. During the first demonstration period, North Carolina began its transition to managed care and invested in novel programs to better respond to the diverse needs of North Carolinians who are enrolled in Medicaid.

North Carolina is ready to build on early successes and lessons learned to continue this progress over the next five years. The State’s overarching goal for the demonstration is to improve health and well-being for all North Carolinians through a whole-person, well-coordinated system of care that addresses both medical and non-medical drivers of health and advances health access by reducing disparities for historically marginalized populations.

Proposed effective dates for Demonstration Renewal are Nov. 1, 2024 to Oct. 31, 2029.

NC Section 1115 Demonstration Waiver Application

Renewal Application
Previously Approved Application
Full public notice 
Abbreviated public notice 
Managed Care Interim Evaluation Report - The draft Managed Care Interim Evaluation Report was submitted to CMS for review Oct. 14, 2023. Therefore, it was not included in the state public comment period but can be found with the application out for federal public comment.

Fact Sheets

NC 1115 Waiver Renewal Fact Sheet
NC 1115 Waiver Renewal Healthy Opportunities Pilot Fact Sheet
NC 1115 Waiver Renewal Justice-involved Fact Sheet

For more information on the pending Substance Abuse Disorders (SUD) waiver extension request,  visit this webpage.

Public Comments

Public comments on the North Carolina Medicaid Reform Demonstration renewal application were accepted from Aug. 21, through Sept. 20, 2023. A list of all the public comments is available.

Interested parties will have the opportunity to officially comment on the demonstration renewal application during the federal public comment period; the submitted application will be available for comment on the CMS website at 
NC Medicaid Reform Demonstration Renewal Public Comments.

Public Hearings

North Carolina hosted five public hearings to seek input regarding the waiver extension request.

  • Sept. 5 from 9:30-11 a.m. (in person)
    Mountain Area Health Education Center (MAHEC)
    Blue Ridge A & B in the Education Building
    121 Hendersonville Road, Asheville NC 28803
  • Sept. 6 from 9:30 -11 a.m. (in person)
    McKimmon Conference & Training Center
    NC State University, 1101 Gorman Street, Raleigh NC 27606
  • Sept. 6 from 5:30-7:00 p.m. 
    Virtual via Microsoft Teams 
    Meeting video 
  • Sept. 7 from 2:30-4 p.m. (in person)
    Greenville Convention Center
    303 SW Greenville Blvd., Greenville NC 27834
  • Sept. 15 from 11:30 a.m.-12:30 p.m., EST During the Medical Care Advisory Committee Meeting (MCAC)
    Virtual via Microsoft Teams