Transformation

North Carolina's Transformation to Medicaid Managed Care

NCDHHS to Submit NC Section 1115 Demonstration Waiver Amendment

Public hearings: Nov. 30 and Dec. 10. Public comments accepted through 5 p.m. Dec. 27, 2021.

Public Notice & Webinar Info

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.

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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 Medicaid Managed Care

County Playbook for Medicaid Managed Care

Provider Playbook for Medicaid Managed Care

Advanced Medical Homes

Behavioral Health I/DD Tailored Plan

Care Management

Health Plans

Healthy Opportunities

Quality Management and Improvement

Specialized Foster Care

Tailored Care Management

Value-Based Purchasing

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 Dec. 1, 2022, for Behavioral Health I/DD Tailored Plans.