NC DHHS Intent to Vaccinate Survey

NC DHHS is looking to gain additional insight into NC practices and their intent to vaccinate. Your response is needed – please click on the link below to take their brief survey!

NC Medicaid Requests Temporary Plan Changes to Respond COVID-19

NC Medicaid Requests Temporary Plan Changes to Respond COVID-19

Mar 18, 2020

The North Carolina Department of Health and Human Services has sought authority from the Centers for Medicare & Medicaid Services to temporarily waive certain Medicaid and NC Health Choice policies as part of North Carolina’s response to the COVID-19. The waivers will provide flexibility to NC Medicaid and providers to address the urgent health care needs of beneficiaries during this public health emergency.

NC Medicaid will use the authority, once granted, to streamline NC Medicaid provider enrollment; waive facility access and length of stay limits, which would allow for example critical access hospitals to have more beds and for patients to stay longer; and allow alternative settings to deliver care such as providing services in home. NC Medicaid requested these flexibilities from CMS on March 17, 2020.

Additionally, NC Medicaid is requesting temporary modifications to home- and community-based services provided through Medicaid state plan waivers, including the Innovations, Community Alternatives for Disabled Adults, Community Alternatives for Children and Traumatic Brain Injury waivers. These requests include removing certain dollar and stay limits, expanding the type of location where services can be delivered and easing requirements for reviews of personalized care plans and in-person meetings. Temporary modifications to waiver services and requirements will be made on an individual basis. NC Medicaid requested these waiver flexibilities on March 13, 2020.

NC Medicaid will share additional details following CMS review and determination. All NC Medicaid requested flexibilities documents, along with other Medicaid-related COVID-19 information, can be viewed at For general COVID-19 information and resources, visit

NC DHHS COVID-19 Healthcare Professional Webinar Series

NC DHHS COVID-19 Healthcare
Professional Webinar Series

in partnership with CCNC and AHEC

CCNC and NC AHEC are working together with NC DHHS to help North Carolina’s healthcare providers address the challenge of the COVID-19 pandemic. Featuring subject-matter experts from CCNC, NC AHEC and representatives of the NC DHHS, this weekly webinar series will address new options for telephonic and telehealth delivery of care for Medicaid beneficiaries, provide a one-stop location gathering the latest information from NC DHHS and the CDC, and deliver practice support coaching to help practices implement new clinical workflows in response to the changing demands of COVID-19.

Register in advance for this webinar:

Carolina Complete Health Awarded Additional Region in Medicaid Managed Care

The North Carolina Department of Health and Human Services (DHHS) has expanded the regions awarded to Carolina Complete Health, Inc. to serve as a prepaid health plan under the state’s transition to Medicaid managed care. In addition to serving regions 3 and 5 in the state, the provider-led health plan will also serve region 4.

DHHS and Carolina Complete Health, Inc. have been working together to ensure the health plan is well-positioned to meet the state’s vision of providing a whole-person system of care that addresses both medical and non-medical drivers of health. As a provider led entity governed by Physicians, CCH brings a unique perspective to Medicaid managed care. The agreement resolves CCH’s contested case pending at the Office of Administrative Hearings.

“Our top priority is meeting the health care needs of the people we serve, while being good stewards of public resources. As a physician, I understand the unique perspective that providers can bring to the health insurance market,” said DHHS Secretary Mandy Cohen, M.D. “We look forward to our continued partnership.”

“Carolina Complete Health is proud to be one of DHHS’ partners in pursuing its transformative, whole-person centered system of care, and we are very pleased to have the opportunity to bring our provider-led health plan to region 4,” said Chris Paterson, CEO of Carolina Complete Health.

Added Bob Seligson, CEO of the North Carolina Medical Society, “Our physicians are committed to providing leadership and governance for Carolina Complete Health to ensure that providers continue to have a central role as DHHS partners in improving the health and well-being of North Carolinians.”

In addition to counties in regions 3 and 5, Medicaid beneficiaries in the following region 4 counties will now have the option to choose Carolina Complete Health, Inc. as their health plan: Alamance, Caswell, Chatham, Durham, Franklin, Granville, Johnston, Nash, Orange, Person, Vance, Wake, Warren, and Wilson.

Open enrollment for Medicaid Managed care began in 27 counties in the state in July. It will launch statewide on October 14th. In 2015, the NC General Assembly enacted legislation directing the Department of Health and Human Services 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 person to provide all services. Transforming North Carolina’s Medicaid program to managed care is the most significant change made since its inception.

Medicaid Managed Care Open Enrollment Webcast: Today at 2:30 PM

Today marks the first day of Phase 1 open enrollment for Medicaid Managed Care. To make sure you are well informed about open enrollment activities and the support available to you, Department Secretary Mandy Cohen, M.D., is hosting a webcast:

NC Medicaid Managed Care Open Enrollment Webcast
Monday, July 15, 2019 at 2:30 PM
Registration is required to access the webcast.

There will be time for questions and answers. Thank you in advance for supporting Medicaid beneficiaries as they enroll for the first time in managed care.

Dave Richard
Deputy Secretary
NC Medicaid
Division of Health Benefits
NC Department of Health and Human Services

Office: 919-855-4101
Mobile: 919-500-1596

1985 Umstead Drive, Kirby Building
2501 Mail Service Center
Raleigh, NC 27699-2501

Takeaways from the August 9th DHHS Stakeholder Call with Mandy Cohen, M.D.

By Leah, Paraschiv, NCMGMA Board Member

On Thursday, August 9th, the NC Department of Health and Human Services (DHHS) held a stakeholder call led by DHHS Secretary Mandy Cohen, M.D. The call addressed DHHS’s upcoming issuance of the Request for Proposal for Prepaid Health Plans (PHP) in Medicaid Managed Care.

In short, DHHS has issued an official RFP for managed care carriers. They will accept proposals until October and announce their final selections in February. Managed care will officially begin in the fall of 2019.

Here are the most important takeaways from the call:

  • PHPs cannot refuse to contract with you.
  • Physicians and physician extenders are guaranteed payment at current rates.
  • DHHS has worked to mitigate administrative burden for clinicians.
  • PHPs will have real accountability and rigorous oversight.
  • You will receive education and support during and after the transition to managed care.

Anticipated Timeline:

  • Now and ongoing — PHPs may start to reach out to initiate contract discussions with clinicians.
  • February 2019 — DHHS will announce which health plans will be PHPs in managed care.
  • Summer 2019 — PHPs must have contracted with enough care providers to meet DHHS network standards.
  • July 2019 — PHPs must have all call centers operational and all relevant staff located in North Carolina.
  • July – September 2019 — Managed care will start in two phases. For regions of the state in Phase 1, this will be the window in which beneficiaries select a PHP.
  • November 2019 — Medicaid Managed Care program will launch in regions in Phase 1.
  • October – December 2019 — For regions of the state in Phase 2, this will be the window in which beneficiaries select a PHP.
  • February 2020 — Medicaid Managed Care will launch in regions in Phase 2.

For additional information on Prepaid Health Plans in Medicaid Managed Care, there is a two page fact sheet available on the NC DHHS website which contains more details specific to the provider community, with even more information for all stakeholders on the full website.

NC DHHS Reports Medicaid Finishes Fiscal Year 2014-15 with $130.7M Cash on Hand

The Department of Health and Human Services reported today that the North Carolina Medicaid program ended the 2014-15 state fiscal year with $130.7 million cash on hand. This is the second consecutive year the Medicaid program has finished with cash on hand.  Follow this link for the complete news release.