Update: Medicaid Transformation in North Carolina

Blog | July 16, 2020


Written by James Coleman


With nearly a year of delay related to a fiscal budget dispute between North Carolina’s Legislature and Governor, the transformation of North Carolina’s Medicaid system from fee-for-service payment to a managed care system will start no later than July 2021.


Ratified by the North Carolina General Assembly in late June and signed into law by Governor Cooper on July 2, Senate Bill 808/SL 2020-88- Medicaid Funding Act provides funding for the North Carolina Department of Health & Human Services (NCDHHS) to start the Medicaid transformation process and stipulates that the department be ready to implement it by July 1, 2021.


Once Medicaid in North Carolina transitions to a managed care system, the NCDHHS Division of Health Benefits will contract with six prepaid health plans to manage care and provide health care services for nearly 2 million of North Carolina’s Medicaid beneficiaries.


For more information on Medicaid transformation, see the following previous blog posts:



What is Medicaid transformation? https://nciom.org/what-is-medicaid-transformation/


Medicaid Transformation vs. Expansion -What’s the Difference? https://nciom.org/medicaid-transformation-vs-expansion-whats-the-difference/


What’s the context for Medicaid transformation, and what’s coming next? https://nciom.org/medicaid-transformation-about-to-kick-in-to-high-gear/


What does/will transformation look like? https://nciom.org/north-carolinas-medicaid-transformation-design/


Healthy opportunities pilots: https://nciom.org/north-carolina-medicaid-healthy-opportunities-pilots/


Data and quality of care: https://nciom.org/using-data-to-promote-quality-of-care-under-medicaid-transformation/


Types of health plans: https://nciom.org/health-plans-under-medicaid-transformation/


What’s a PHP, and why should we care? https://nciom.org/what-are-prepaid-health-plans/