NC's 1115 Waiver Approved by CMS

North Carolina received federal approval on October 24 from the Centers for Medicare & Medicaid Services (CMS) of the amended 1115 Demonstration Waiver application that DHHS submitted last November. Receiving waiver approval is a major milestone toward implementing North Carolina’s Medicaid Managed Care and moving the state’s health care system toward further integration and coordination. We appreciate the extensive input from clinicians, beneficiaries, hospitals, counties, health plans, elected officials, advocates and other stakeholders to develop the waiver.

With today’s waiver approval, North Carolina was given the authority to implement the transition to Medicaid Managed Care and integrate physical health, behavioral health and pharmacy benefits. This transition toward whole person care also includes the authority to create Tailored Plans to serve people with intellectual/developmental disabilities (I/DD) or higher-intensity behavioral health needs, and a specialized behavioral health home model to ensure strong care management for those individuals. To support broader state efforts to combat the opioid crisis and improve access to treatment, DHHS received authority to implement new flexibilities that allow for treatment of substance use disorder in institutions of mental disease (IMDs). The approved waiver also gives North Carolina federal authority to implement through its managed care plans an innovative Healthy Opportunities pilot program, which will identify cost-effective ways for managed care plans to deliver whole person care and ensure that Medicaid dollars are purchasing value. Please note that the approved waiver focuses only on the aspects of North Carolina’s Medicaid managed care transformation that require CMS approval.

DHHS Secretary Mandy Cohen, M.D. will hosts a webcast on the 1115 waiver and what approval means to North Carolina’s transition to Medicaid Managed Care on Friday, October 26 from 1:00-2:00pm. Click here to register to view and listen to the webcast. Note that the webcast can be seen and heard only through a computer or smartphone. Make sure your computer speakers or smartphone audio is on and the volume turned up when you join the webcast.

Additional waiver materials, including a fact sheet, original and amended waiver applications, CMS approval letter and other transformation information may be found on the NC Medicaid transformation website.