Proposed Program Design
Policy Papers and Final Policy Guidance
DHHS Medicaid Managed Care policy papers and final policy guidance documents focus on NC Medicaid Managed Care program features.
NC Section 1115 Demonstration Waiver
On Oct. 24, 2018, the federal Centers for Medicare and Medicaid Services (CMS) approved North Carolina's 1115 Demonstration Waiver application submitted November 2017. The approval is effective Jan. 1, 2019, through Oct. 31, 2024. See the NC Section 1115 Demonstration Waiver webpage here. Additional information and links to the CMS 1115 website are available here.
NC Section 1115 Demonstration Waiver Amendment Requests
- SUD Waiver Extension Application - July 28, 2023
- SUD Waiver Extension Public Notice - July 28, 2023
- SUD Waiver Extension Abbreviated Public Notice - July 28, 2023
- Amendment Application - March 31, 2023 (revised July 28, 2023)
- Public Notice - March 31, 2023 (revised July 28, 2023)
- Abbreviated Public Notice - March 31, 2023 (revised July 28, 2023)
- Supplement to Amendment Application - Dec. 17, 2021
- Amendment Application - Nov. 15, 2021
- Public Notice - Nov. 19, 2021
- Abbreviated Public Notice - Nov. 19, 2021
Public Comment
The SUD waiver extension application is now open for public comment until 5 p.m. on August 28, 2023. Comments may be emailed to Medicaid.NCEngagement@dhhs.nc.gov. Please indicate “NC Section 1115 Waiver” in the subject line of the email message.
Written comments may be sent to the following address (please indicate “NC Section 1115 Waiver” in the written message):
North Carolina Department of Health and Human Services
NC Medicaid Section 1115 Waiver Team
1950 Mail Service Center
Raleigh, NC 27699-1950
Public Hearings
North Carolina hosted two public hearings to seek input regarding the request to extend the North Carolina Section 1115 Demonstration Project for Residential and Inpatient Treatment for Individuals with a Substance Use Disorder (SUD).
Public hearing - Tuesday, April 11, 2023, 5 p.m. (RSVP link removed after event occurred)
Public hearing - Thursday, April 13, 2023, 2 p.m. (RSVP link removed after event occurred)
North Carolina Section 1115 Demonstration Project for Residential and Inpatient Treatment for Individuals with a Substance Use Disorder (SUD) Public Hearing
Wednesday, Nov. 17, 2021, noon
Community Partners Webinar: Updates on NC Medicaid Managed Care, Healthy Opportunities and a Public Hearing for the 1115 Waiver Amendment
Monday, Nov. 22, 2021, 5 p.m.
Webinar-based Public Hearing for NC Medicaid’s 1115 Waiver Amendment
Tuesday, Nov. 30, 2021, 5 p.m.
Webinar-based Public Hearing for NC Medicaid’s 1115 Waiver Amendment
Friday, Dec. 10, 2021
Presentation and Q&A as part of the MCAC Quarterly Meeting
NC Section 1115 Demonstration Waiver Evaluation Design
Amended NC Section 1115 Demonstration Waiver
- Section 1115 Demonstration Waiver Webcast - Oct. 26, 2018
- Webcast Presentation - Oct. 26, 2018
- Webcast Transcript - Oct. 26, 2018
- Fact Sheet - Oct. 18, 2018
- CMS Approval Letter - Oct. 19, 2018
- Press Release - Oct. 24, 2018
- Amended NC Section 1115 Demonstration Waiver Application - Nov. 20, 2017
- Initial NC Section 1115 Demonstration Waiver Application - June 1, 2016
Proposed NC Medicaid Managed Care Program Design
In August 2017, DHHS released a detailed proposed program design for transforming the state Medicaid and NC Health Choice programs to managed care. This proposed design document ensured that providers had an opportunity to review and comment on the specific of the DHHS vision for managed care prior to submitting the amended Section 1115 demonstration waiver application to CMS in November 2017.
Medicaid Managed Care Proposed Program Design - August 2017
Medicaid Managed Care Proposed Program Design Public Comment Summary - August/September 2017
Proposed Program Design Information for Beneficiaries and Providers
Below are key points of the proposed program design, specifically for providers or beneficiaries.
Medicaid Managed Care: A guide for people with North Carolina Medicaid - August 2017
Provider Rate Floor and Reimbursement Scenarios
May 31, 2018–"Provider Rate Floor and Reimbursement Scenarios for North Carolina PHPs," prepared by DHHS, outlines reimbursement requirements for Prepaid Health Plans under various scenarios based on the interaction among rate floors, in-network service availability and a provider's in-network or out-of-network status in the context of North Carolina Medicaid managed care. The document addresses reimbursement for Medicaid covered benefits. Per member per month payment requirements for Advanced Medical Homes and care management functions are outside the scope of this document.
Public Hearings and Listening Sessions
DHHS knows it is crucial to listen to and learn from the people who live and work with Medicaid every day. To develop the strongest Medicaid program for North Carolina, DHHS continues to talk with providers, beneficiaries and advocates, health care experts across the state and the country, leaders in other states who have already transitioned Medicaid programs to managed care, and many others interested in improving the health of North Carolinians. DHHS is committed to continuing this partnership.
Medicaid Managed Care Public Comments Summary - April/May 2017 - Input from written comments and public listening sessions held by DHHS throughout the state
This page was last modified on 08/21/2023