NC Medicaid
We have compiled resources to help you navigate the publish mental health system in North Carolina. Please contact us if you encounter problems or have concerns not address by these resources.
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Standard Plans | Tailored Plans | Children and Family Specialty Plan
Reversing the October 1, 2025 Medicaid Rate Cuts
NC Medicaid Standard Plans and Tailored Plans have outlined a process to restore Medicaid reimbursement rates to pre–October 1, 2025 levels as quickly as possible. Any outstanding recoupments related to the October 1 fee schedule changes have been canceled effective immediately.
NCDHHS issued revised fee schedules on January 5, 2026 that reflect both the restored rates and current coding standards. Plans will have up to 45 days to implement the fee schedules, followed by up to 30 days to reprocess impacted claims. Plans have indicated they intend to move more quickly where possible.
For 98% of claims, practices won’t have to do anything. Plans will pay practices the difference between the reduced rate and the increased rate now in place. Members are encouraged to monitor communications from their Standard or Tailored Plan for additional details and timeline updates.
To learn more about the process to reverse the October 1 rate cuts, click here.
Standard Plans
The Standard Plans cover "mild to moderate" mental illnesses in the Medicaid population, and psychiatrists will be included in the networks to help take care of these patients. These plans are required to accept "any willing provider" who meets quality standards and accepts the Plan reimbursement rate.
NC DHHS is requiring that all of the Plans use the NC DHHS credentialing and enrollment system, a single statewide formulary to streamline the process.
Resources:
NC DHHS
For more information on Medicaid Transformation developments, visit the NC DHHS website.
AmeriHealth Caritas
Provider Support Number: 888-738-0004
Behavioral Health Medical Director: Nerissa Price, MD
Carolina Complete Health
Provider Support Number: 833-552-3876
Behavioral Health Medical Director: Nena Lekwauwa, MD
Healthy Blue
Provider Support: 844-594-5072
Behavioral Health Medical Director: Steve Bentsen, MD
United Healthcare
Provider Support: 800-638-3302
Behavioral Health Medical Director: Barbara Wise, MD
WellCare
Provider Support: 866-799-5318
Behavioral Health Medical Director: Therese Garrett, MD
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Tailored Plans
North Carolina launched Tailored Plans on July 1, 2024, these will be integrated health plans for individuals with behavioral health, I/DD needs, or those on innovations or TBI waivers or waitlists. Approximately 200,000 beneficiaries will be enrolled in Tailored Plans.
Tailored Plans will remain regional, and they will be able to close their provider panels as needed. They will cover all the behavioral health services covered by the Standard Plans but will also exclusively cover some enhanced behavioral health services (such as Intensive In-Home, ACT, and Residential SUD treatment).
Psychiatrists are encouraged to contract with each Tailored Plan in their service area. Once contracted has been completed, it takes approximately two to three weeks to be added into the Tailored Plan system and show up as an in-network provider.
Provider Contracting
Alliance
Chief Medical Director: Robert MacArthur, MD
Partners Health Management
Chief Medical Officer: Charles "Steve" Edwards, MD
Trillium Health Resources
Chief Medical Officer: Michael Smith, MD
Vaya Health
Chief Medical Officer: Richard Zenn, MD
Resources:
Fact Sheet: What Providers Need to Know: Part 1
NCDHHS Training Resources
Recorded NC Medicaid Training Courses
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Children and Families Specialty Plans
The Children and Families Specialty Plan launched on December 1, 2025 as a single, statewide NC Medicaid Managed Care plan that will wrap Medicaid-enrolled children and their families in the child welfare system with seamless, integrated, and coordinated health care. Blue Cross and Blue Shield of North Carolina will manage the plan under the name Healthy Blue Care Together.
The CFSP provides comprehensive coverage for all services provided by the Standard Plan in addition to most Tailored Plan services, such as 1915(i) Home and Community-Based Services and enhanced behavioral health and residential services. It also includes a broad range of behavioral health services such as outpatient therapy, inpatient treatment, and crisis and therapeutic residential options for children. Additionally, the CFSP is responsible for addressing unmet health-related resource needs, including housing, food, transportation, and interpersonal violence. The plan also covers pharmacy, long term services and supports (LTSS) and Intellectual/ Developmental Disability (I/DD) services.
For information about the CFSP, please visit the Children and Families Specialty Plan webpage.
Health Blue Care Together
Chief Medical Officer: Dana Hagele, M.D., M.P.H.
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