Medicaid Bulletin

This bulletin provides guidance on the 2026 – 2027 influenza season for NC Medicaid.

Updated guidance on the Legally Responsible Individual as the Paid Caregiver in the CAP/C HCBS waiver Consumer Directed model.

Clarifications to providers on concurrent billing for Clinical Coverage Policy 8F.

Effective July 1, 2026, NC Medicaid launched a targeted expansion of School-Based Services by Local Education Agencies.

Revisions to areas include definitions, eligibility and coverage criteria, specific criteria covered, transition and discharge planning and more.

Appointment dates and times will no longer be scheduled for provider site visits

Providers should take advantage of the 70-day timeframe given to ensure completion without adverse action.

NC Medicaid Managed Care Incremental Innovations Waiver DCW Rate Increases effective October 1, 2026, retroactive to July 1, 2026.

The Centers for Medicare & Medicaid Services released the 2027 ICD-10 code list, Effective Oct. 1, 2026.

Including a behavioral health post-enrollment accreditation update, recent provider communications and more.