Issued: September 30, 2025
The North Carolina Department of Health and Human Services (NCDHHS) announced that provider reimbursement rates for Medicaid-funded services will be reduced beginning Oct. 1, 2025. Partners is delaying implementation until Nov. 1, 2025, to help minimize the immediate impact on providers.
Background:
Each year, the Medicaid program must be “rebased” to align the state budget with the actual cost of providing care. This year, NCDHHS requested significantly more funding than the General Assembly allocated. Although both the House and Senate passed legislation to provide additional rebase funds, they did not reach a compromise, leaving the budget gap unresolved. To address the shortfall, NCDHHS is reducing provider reimbursement rates.
What is happening?
- Rate reductions are effective Oct. 1, 2025. Depending on the service category, providers will see reductions of 3%, 8%, or 10%.
- LME/MCOs, including Partners, will implement rate changes on Nov. 1, 2025.
- Claims submitted in October and paid at the former (higher) rate will be recouped by each LME/MCO after Nov. 1, 2025.
- If, before Nov. 1, NCDHHS decides that rate cuts are not needed—based on action by the legislature, the Governor, or the NCDHHS itself—the LME/MCOs will not implement the reductions.
- Please note that Partners is not accepting requests for provider rate enhancements at this time.
What do providers need to do?
Providers should prepare for adjustments in claims and reimbursement effective Nov. 1, 2025, and monitor communications from Partners for further updates.
Who can providers and members contact if they have questions?
Questions related to claims reprocessing can be sent to claimsdepartment@partnersbhm.org.