Transformation

North Carolina's Transformation to Medicaid Managed Care

New Start Date for Tailored Plans is April 1, 2023

To ensure beneficiaries can seamlessly receive care on day one, NCDHHS will delay the implementation of Tailored Plans until April 1, 2023. Specific new services will still go live Dec. 1, 2022.

DHHS Press Release

NC Medicaid Managed Care Launches

Starting July 1, nearly 1.6 million Medicaid beneficiaries in North Carolina began receiving the same Medicaid services in a new way through NC Medicaid Managed Care health plans.

Learn More

Beneficiaries

What You Need to Know to Use NC Medicaid Managed Care

Providers

NC Medicaid Managed Care Fact Sheets and Quick Reference Guides

Starting July 1, 2021, most Medicaid beneficiaries began receiving the same Medicaid services in a new way. Called "NC Medicaid Managed Care," beneficiaries choose a health plan and get care through a health plan's network of doctors. Some beneficiaries are remaining in traditional Medicaid, which is called NC Medicaid Direct.

Beneficiary Information for NC Medicaid Managed Care

County Playbook for NC Medicaid Managed Care

Provider Playbook for NC Medicaid Managed Care

Advanced Medical Homes

Behavioral Health I/DD Tailored Plan

Care Management

Health Plans

Healthy Opportunities

Quality Management and Improvement

Children and Families Specialized Plan (formerly Specialized Foster Care)

Tailored Care Management

Value-Based Purchasing

NC Integrated Care for Kids (InCK)

NC Medicaid Managed Care

In 2015, the NC General Assembly enacted legislation directing DHHS to transition Medicaid and NC Health Choice from fee-for-service to managed care. Under managed care, the state contracts with insurance companies, which are paid a predetermined set rate per enrolled person to provide all services.

In July 2020, legislation authorized NC Medicaid Managed Care to begin July 1, 2021, for Standard Plans and April 1, 2023, for Behavioral Health I/DD Tailored Plans.