Transition of Care

The North Carolina Department of Health and Human Services (DHHS) developed policies and procedures for Transition of Care to support beneficiaries who transition between Medicaid Direct (fee-for-service) and Medicaid Managed Care delivery systems. The Transition of Care design intends 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.


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.

NC Medicaid will host a webinar overview of the Transition of Care Policy on Thursday, March 11, 2021, from 12 noon to 1 p.m. Please pre-register for the webinar

For questions about the Transition of Care Policy, please email


Transition of Care Data Specification Guidance