Proposed Program Design

Policy Papers and Final Policy Guidance

DHHS Medicaid Managed Care policy papers and final policy guidance documents focus on NC Medicaid Managed Care program features.

NC Section 1115 Demonstration Waiver

On Oct. 24, 2018, the federal Centers for Medicare and Medicaid Services (CMS) approved North Carolina's 1115 Demonstration Waiver application submitted November 2017. The approval is effective Jan. 1, 2019, through Oct. 31, 2024.

NC Section 1115 Demonstration Waiver Amendment Request

Public Hearings

Wednesday, Nov. 17, 2021, noon
Community Partners Webinar: Updates on NC Medicaid Managed Care, Healthy Opportunities and a Public Hearing for the 1115 Waiver Amendment

Monday, Nov. 22, 2021, 5 p.m.
Webinar-based Public Hearing for NC Medicaid’s 1115 Waiver Amendment

Tuesday, Nov. 30, 2021, 5 p.m.
Webinar-based Public Hearing for NC Medicaid’s 1115 Waiver Amendment

Friday, Dec. 10, 2021
Presentation and Q&A as part of the MCAC Quarterly Meeting

Public Comments

Per the public notice, comments prior to submission to CMS were accepted through 5 p.m. Eastern on Dec. 27, 2021.

NC Section 1115 Demonstration Waiver Evaluation Design

Amended NC Section 1115 Demonstration Waiver

Proposed NC Medicaid Managed Care Program Design

In August 2017, DHHS released a detailed proposed program design for transforming the state Medicaid and NC Health Choice programs to managed care. This proposed design document ensured that providers had an opportunity to review and comment on the specific of the DHHS vision for managed care prior to submitting the amended Section 1115 demonstration waiver application to CMS in November 2017.

Medicaid Managed Care Proposed Program Design - August 2017

Medicaid Managed Care Proposed Program Design Public Comment Summary - August/September 2017

Proposed Program Design Information for Beneficiaries and Providers

Below are key points of the proposed program design, specifically for providers or beneficiaries.

Medicaid Managed Care: A guide for people with North Carolina Medicaid - August 2017

Medicaid Managed Care: A guide for North Carolina Medicaid and NC Health Choice providers - August 2017

Provider Rate Floor and Reimbursement Scenarios

May 31, 2018–"Provider Rate Floor and Reimbursement Scenarios for North Carolina PHPs," prepared by DHHS, outlines reimbursement requirements for Prepaid Health Plans under various scenarios based on the interaction among rate floors, in-network service availability and a provider's in-network or out-of-network status in the context of North Carolina Medicaid managed care. The document addresses reimbursement for Medicaid covered benefits. Per member per month payment requirements for Advanced Medical Homes and care management functions are outside the scope of this document.

Public Hearings and Listening Sessions

DHHS knows it is crucial to listen to and learn from the people who live and work with Medicaid every day. To develop the strongest Medicaid program for North Carolina, DHHS continues to talk with providers, beneficiaries and advocates, health care experts across the state and the country, leaders in other states who have already transitioned Medicaid programs to managed care, and many others interested in improving the health of North Carolinians. DHHS is committed to continuing this partnership.

Medicaid Managed Care Public Comments Summary - April/May 2017 - Input from written comments and public listening sessions held by DHHS throughout the state