Medicaid Bulletin

Articles published prior to January 2018 are available in the Medicaid Bulletin Archive.

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Updates to NC Medicaid Coverage for Wegovy and Zepbound for Clinical Indications Other than Weight Loss
Wegovy and Zepbound for indications other than weight loss to be covered based on the indications and usage criteria published in the FDA label, pending updated clinical criteria.
Reminders About Required Provider Disclosures
Exclusion Sanction questions must be accurately answered on applications and new adverse actions must be reported to the Department.
Comprehensive Clinical Assessment Requirements
A psychiatric diagnostic interview (Current Procedural Terminology 90792) may qualify as a Comprehensive Clinical Assessment if it meets all requirements.
UPDATED: NC Medicaid Rate Reductions – Effective Oct. 1, 2025
This bulletin replaces in full NC Medicaid Rate Reductions – Effective Oct. 1, 2025, published Sept. 25, 2025.
Assessment Rate Adjustment for Skilled Nursing Facility Providers
Effective Oct. 1, 2025, NC Medicaid adjusted the provider assessment rates.
Providers with License Limitations or Non-Practice Agreements Ineligible for NC Medicaid Participation
Important changes effective Oct. 1, 2025, for providers with any form of license limitation.
Cost of Dispensing Survey
The five-year cost of dispensing survey has been completed for North Carolina pharmacies.
Flexibilities to Ensure Continuity of Care and Ease Provider Administrative Burden at Children and Families Specialty Plan Launch
Includes medical and pharmacy prior authorizations, out-of-network provider rates and rules and primary care provider changes.
Primary Care Provider/Advanced Medical Home Auto-Assignment Fact Sheet Now Available
The fact sheet outlines the key responsibilities of practices receiving auto-assigned members.
Discontinuation of Coverage: Xifaxan (Rifaximin)
Effective Oct. 1, 2025, NC Medicaid will no longer cover the prescription drug Xifaxan (Rifaximin).