NC Medicaid Increases Support to Protect Individuals Most at Risk for Serious Illness Living in Nursing Homes and Adult Care Homes from COVID-19

The North Carolina Department of Health and Human Services (NCDHHS) Division of Health Benefits (NC Medicaid) is providing additional funding to support nursing homes and adult care homes for older adult Medicaid beneficiaries diagnosed with or at high risk of contracting COVID-19. 

This targeted Medicaid funding will further enable nursing homes and adult care homes to provide the more intensive care needed for residents with COVID-19 and limit the spread of the virus to other residents and staff. NC Medicaid will offer expedited hardship advances and enhanced reimbursement rates to facilities with multiple COVID-positive residents. These relief measures will address immediate cash flow needs caused by sharply rising costs and the expense to maintain an elevated level of care over the course of the public health crisis. 

Nursing and adult care homes are particularly vulnerable to COVID-19 outbreaks and have been identified as high risk by the Centers for Disease Control and Prevention. In response, the state has taken several actions. Governor Roy Cooper issued Executive Orders codifying directives to help prevent outbreaks. NCDHHS has provided ongoing prevention and response support to local health departments and facilities. NC Medicaid provided a rate increase last month for all long-term care providers to help them implement preventive measures including setting up of isolation spaces for residents who test positive with COVID-19, monitoring staff for symptoms of COVID-19 and providing masks to residents with respiratory symptoms.  

The expedited hardship process announced today will enable providers to receive an advance payment of up to two months of reimbursement based on the facility’s prior claims history. This new expedited process builds on NC Medicaid’s current hardship process and simplifies the steps providers must take to access and eventually pay back the funds. Effective April 1, 2020, nursing homes and adult care homes with a COVID-19 outbreak will receive an increase in their daily per patient reimbursement rate for every person in the facility. 

Nursing homes will also receive a specified add-on rate for each person testing positive for COVID-19. These targeted funds will enable facilities to increase screening, enhance cleaning protocols, purchase additional cleaning supplies and protective equipment, while also addressing staffing needs, staff reimbursement and implementation of other infection control measures.  

NC Medicaid continues to evaluate the effects of the COVID-19 emergency on all Medicaid providers, particularly long-term care providers, and anticipates providing additional resources to support their critical work in the near future.

For additional details on NC Medicaid COVID-19 reimbursement for long-term care facilities and the associated communication bulletin for nursing and adult care home providers, visit the Medicaid website at www.medicaid.ncdhhs.gov/coronavirus. 

Current COVID-19 guidance and resources are available online at www.ncdhhs.gov/coronavirus.