Medicaid Bulletin

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

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Rate Increase for Personal Care Services and the Community Alternatives Program
This Medicaid Bulletin has been completely replaced by an updated version published on Aug. 4, 2026. Please see the Updates to Rate Increase for Personal Care Services and the Community Alternatives Program bulletin, for the latest information.
Sixth Annual Virtual Statewide Standard Plan Quality Forum
NC Medicaid, in collaboration with the four NC Medicaid Managed Care Standard Plans, will host the Sixth Annual Virtual Statewide Quality Forum on Wednesday, Oct. 14, 2026, from 11 a.m. to 1 p.m.
Update to North Carolina Medicaid Due Process/Appeals Unit Fax Number for Claim Review
The updated fax number is effective as of July 15, 2026. This bulletin applies to NC Medicaid Direct.
Some Qualified Medicare Beneficiaries Now Have Coverage for Family Planning Services
For eligible individuals, NC Medicaid will now pay for Family Planning services in addition to Medicare premiums and cost sharing.
Reminder: Requirements for Research-Based Behavioral Health Treatment Service Delivery
This bulletin applies to all research-based behavioral health treatment providers in NC Medicaid Managed Care and NC Medicaid Direct.
Clinical Coverage Policy Update 1A-20 Sleep Studies and Polysomnography Services
Amendments to Clinical Coverage Policy 1A-20, expanding medical necessity criteria and updating coverage for sleep studies and polysomnography services are effective July 1, 2026.
NC Medicaid Managed Care Capitation Rates – Updated Care Management Assumptions for SFY 2027
Care Management rate considerations effective July 1, 2026.
Off-cycle Provider Reverification Taking Place This Fall for Certain Providers
Impacted NC Medicaid providers will be included in the Active Provider Reverification Report, and notifications with specific deadlines are expected by the end of September 2026.
Transition to American Medical Association Maternity Current Procedural Terminology 2027 Code Changes Effective Jan. 1, 2027
Beginning Jan. 1, 2027, all current maternity service codes, including global billing, will be deleted from the fee schedule.
Key Updates to NC Medicaid Clinical Coverage Policy 10A, Outpatient Specialized Therapy Services
Effective July 1, 2026, NC Medicaid has amended Clinical Coverage Policy 10A, Outpatient Specialized Therapy Services.