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What the North Carolina Medicaid managed care bill means for your practice

In a delayed step toward Medicaid expansion, North Carolina implemented a law in July that is impacting healthcare providers across the Tar Heel state. As one of the few states holding out on Medicaid expansion under the Affordable Care Act (ACA), the state passed legislation that calls for “privatization of Medicaid in North Carolina, switching to a model that involves the state contracting with for-profit managed care companies.”1

These Medicaid managed care plans are part of Gov. Roy Cooper’s efforts to expand Medicaid under the ACA. Healthcare providers are already feeling the impact of the new measure.

How the new law is impacting NC providers

First, with expansion of Medicaid, more patients will be eligible for Medicaid plans. As a result, you will likely see more patients moving between these plans to find the best fit for their healthcare coverage needs.

Under the new law, Medicaid beneficiaries may change their plans for any reason within the first 90 days of coverage.2 With plan changes, you will likely see an increase in the need for eligibility verifications for many of your patients.

Also, with the privatization of Medicaid plans, providers may lose the capability to submit claims through the North Caroline state Medicaid portal. Claims submissions will likely need to be completed through individual payers’ portals – or through a clearinghouse service – if the state site is no longer an option.

With this step toward Medicaid expansion in North Carolina, you can expect to see more patients covered by Medicaid managed care plans. This may impact your payer mix, creating new challenges for billing and claims management workflows.

Along with the challenges come new opportunities. Fortunately, with the right eligibility verification and claims submission technology, providers can meet current and emerging challenges head on. To find out how Inovalon can help automate eligibility checks and streamline claims submissions, request a demo today.



  1. “North Carolina and the ACA’s Medicaid Expansion,” Louise Norris, September 14, 2020.
  2. Open Enrollment Information for NC Medicaid Managed Care”, Brunswick County Government website. Accessed Sep. 23, 2021,

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