About the NC Medicaid Reform Plan

In September 2015, North Carolina passed a law to change the way Medicaid services are delivered in our state. This law directed the Department of Health and Human Services to create a "Medicaid Reform" plan that will help doctors and other health care professionals focus even more on quality care and making patients healthier, while controlling costs to taxpayers.

Although the official public comment period ended April 18, the Department welcomes your thoughts about the Medicaid reform plan.

Questions and Answers

Last update: March 30, 2016

Medicaid Reform Waiver Application (Section 1115 Demonstration)

A draft of the Medicaid Reform plan waiver application was presented to the NC General Assembly March 1. Input received during the public comment period (which ended April 18) are being reviewed and will be used to prepare the final waiver application that will be submitted to the federal Centers for Medicare & Medicaid Services (CMS) June 1. CMS will take about 18 months or so to review the waiver application. CMS must approve the waiver application before the NC Medicaid reform plan can begin to be implemented.

Read the June 1, 2016, North Carolina Medicaid and NC Health Choice (Section 1115 Demonstration) Application.

NC Health Transformation Center Report

The North Carolina Health Transformation Center (NCHTC) will be an integral part of Medicaid reform. The NCHTC will drive health outcome improvements by nurturing promising innovations throughout the state health care system. The NCHTC also will promote continued partnerships with providers and care organizations.The report includes insights from other states’ experiences, what North Carolina needs to successfully develop a health transformation center, technology impacts, and proposed governance structure.

Read the May 1, 2016, NC Health Transformation Center Report.

Medicaid Reform Report

The North Carolina General Assembly has assigned a committee of legislators to oversee Medicaid Reform. These state representatives and senators are called the Joint Legislative Oversight Committee on Medicaid and NC Health Choice. Before the full General Assembly convened April 25, the Department made a monthly presentation to the committee to share progress on the Medicaid Reform plan. On March 1, the Department submitted a final report on Medicaid reform.

Read the March 1, 2016, Medicaid Reform Report to the Joint Legislative Oversight Committee on Medicaid and NC Health Choice.

Proposed Regions

State law directs that there will be 6 Medicaid regions across North Carolina as part of the Medicaid reform plan. Beneficiaries will choose one Medicaid health care plan from several offered in the region where they live.

There will be at least 4 Medicaid health care plans available in every region. Three of these plans will cover Medicaid services anywhere in the state. There will be 1 or more plans that cover Medicaid services anywhere in the region. Beneficiaries can choose the plan that fits their own needs.

In the proposed regions, counties are carefully assigned to a region to make it easy as possible for beneficiaries to get the care they need. The Department looked at patterns from Medicaid claims to find the:

Places people go to get health care
Doctors and other health care professionals who offer Medicaid services
Hospitals, clinics and other places that offer Medicaid services

The Department also looked at travelling to get care. For example, do people have to drive long distances to see a doctor? Are major roads or highways close by? Does weather make the drive difficult or even impossible at times?

It also is important to make sure a region will have a good balance of patients and Medicaid professionals. For example, too many doctors could make it difficult to get enough patients to successfully run a medical practice. Too few doctors, and people may not get care when they need it.

The 6 regions will start after the Medicaid reform plan has been approved by the federal government and the Medicaid health plans are chosen.

The mix of Medicaid health care providers and where beneficiaries seek care in Alamance County made it a challenge to assign the county to only one region. As a result, the Department is proposing that Alamance County be a test case, and belong in Region II and Region IV. The test case results and feedback received will help determine the final approach.

Medicaid Reform Waiver Application Public Hearings

Twelve public hearings were held across the state during the Medicaid reform waiver application public comment period.