Policy Papers

Policy Guidance

NC Medicaid Final Policy Guidance documents outline the final policies that will govern certain NC Medicaid Managed Care features or programs. The Department appreciates previous stakeholder input, which helped shape final policies. The Department reserves the right to amend or update policies as needed. Questions about the final policies are welcome. Please send an email to Medicaid.NCEngagement@dhhs.nc.gov.

• Behavioral Health I/DD Tailored Plan Criteria Review Update on Eligibility and Enrollment - Updated March 2024
• Appendix B - Behavioral Health I/DD tailored Plan Criteria - Updated April 2024
• NCDHHS Transition of Care Policy - Feb. 25, 2021
• Behavioral Health I/DD Tailored Plan Memo on State-Funded Services Design Updates - Aug. 20, 2020
• Behavioral Health Crisis System Memo for Standard Plans - March 6, 2020

Policy Papers

DHHS Medicaid Managed Care policy papers focus on NC Medicaid Managed Care program features. Policy papers typically include a public comment period. Although these technical papers are primarily written for providers and health plans that want to participate in Medicaid Managed Care, all comments are welcome and encouraged. Please send an email to Medicaid.NCEngagement@dhhs.nc.gov.

Feedback Requested on New Advanced Medical Home Standardized Performance Incentive Program Draft Policy Guide

The Advanced Medical Home (AMH) is NC Medicaid’s cornerstone primary care program, serving more than 2 million Medicaid members across the state. Innovative primary care payment is critical to supporting practice improvements that lead to the outcomes that matter to Medicaid enrollees and their families.

Prepaid health plans (PHPs) are currently required to offer performance incentive payment arrangements to AMH practices based on a defined set of AMH quality measures. However, provider feedback and formal PHP reporting indicate that each PHP’s individual approach to these arrangements vary widely. This variability makes it difficult for AMH practices to consistently participate in incentive arrangements across plans, and to focus and align their quality improvement efforts for Medicaid members.  

To address these administrative and clinical challenges, NC Medicaid plans to implement the AMH Standardized Performance Incentive program in 2026. Additional details can be found in the following draft policy guide document (below) shared for community partner input.

• AMH Standardized Performance Incentive Program DRAFT Policy Guide

NOTE: Community feedback is requested by April 21, 2025, on the AMH Standardized Performance Incentive Program draft policy guide.

Additional Policy Papers

• Ensuring Access to Gene Therapies to Address Sickle Cell Disease in Medicaid - Feb. 19, 2024
• Collaborative Care Model in North Carolina Policy Paper - Dec. 8, 2023
• Medicaid Delivery Reform and Value-Based Payment Market Update - Nov. 17, 2022
• North Carolina’s Specialized Foster Care Plan - Feb. 11, 2021
• Transition of Care Draft Policy - Released Feb. 5, 2020.
• Política de transición de la atención médica - Released Feb. 5, 2020.
• Behavioral Health I/DD Tailored Plan Request for Applications (RFA) Pre-Release Policy Paper - Released Jan. 30, 2020.
• North Carolina’s Value-Based Payment Strategy for Standard Plans and Providers in Medicaid Managed Care - Released Jan. 8, 2020.
• North Carolina’s Medicaid Accountable Care Organizations for Standard Plans and Providers: Building on the Advanced Medical Home Program to Drive Value-Based Payment - Released Jan. 8, 2020.