Transition of Care

The North Carolina Department of Health and Human Services (NCDHHS) developed policies and procedures for Transition of Care to support beneficiaries who transition between NC Medicaid Direct and NC Medicaid Managed Care delivery systems. The Transition of Care is designed to maintain continuity of care for each beneficiary and minimize the burden on providers during transition.

Along with the established Transition of Care policy, the Department has established technology and process requirements for all stakeholders to support the Transition of Care design.

Updates

Transition of Care Policy

Consistent with federal requirements and NC Medicaid’s vision to ensure continuity of care for members transitioning between prepaid health plans (PHPs) or service delivery systems, NC Medicaid has released the NCDHHS Transition of Care Policy. The draft policy was released for public comment in February 2020 and finalized on Feb. 25, 2021 (updated January 1, 2023).

• NCDHHS Transition of Care Policy
• Política de transición de la atención médica

Forms for Transition of Care

• Transition of Care Warm Handoff Summary
• Transition of Care Warm Handoff Summary (Spanish)
• For questions about the Transition of Care Policy, please email Medicaid.NCEngagement@dhhs.nc.gov.

Transition of Care Disenrollment Protocols

• TOC Protocol between Standard Plan Health Plans and LME MCOs
• TOC Protocol Disenrollment due to Dual Eligibility
• TOC Protocol Disenrollment due to Extend NF Stay 
• TOC Protocol Disenrollment Due to Foster Care Enrollment 

Resources

• Transition of Care Data Specification Guidance
• Navigating North Carolina’s Transition to NC Medicaid Managed Care: A Fact Sheet for Members
• Fact Sheets and Reference Guides for Providers
• NC Medicaid Managed Care Transformation: A Fact Sheet for CMARC and CMHRP Providers