Issued: December 22, 2025
The North Carolina Department of Health and Human Services announced on Dec. 10, 2025, the reversal of Medicaid reimbursement rate reductions for NC Medicaid Direct and NC Medicaid Managed Care that took effect Oct. 1, 2025. This announcement applies to:
- The 3%-10% Medicaid rate reductions that took effect Oct. 1, 2025, and impacted doctors, hospitals and other medical providers statewide.
- Reinstatement of GLP-1s for weight management, effective Dec. 12, 2025.
- Reversal of rate reductions for non-emergency medical transportation (NEMT) based on a phased-in approach, effective Dec. 10, 2025.
NCDHHS is taking immediate action to update fee schedules to align with rates and coverage previously in effect Sept. 30, 2025.
What do providers need to know?
- Providers should be informed that this alert replaces and negates the previous alert sent on Dec. 8, 2025: https://legacy.providers.partnersbhm.org/update-provider-rate-reduction-implementation-2/
- Providers should also be informed that the state has given health plans until Jan. 20, 2026, to make the changes for GLP-1s for weight management. This means that if providers submit a claim prior to that date, it may be denied.
What do providers need to do?
- Watch for a provider communication from Partners for when GLP-1 Prior Authorizations will be accepted under the new requirements.
- Providers should read the state’s information at the links below.
Where can providers get more information?
Providers can get more information from the NCDHHS website:
- Medicaid Rate Reduction Reversal Update
- NC Medicaid to Reinstitute Coverage of GLP-1s for Weight Management
- Non-Emergency Medical Transportation Rate Reduction Update
Who can providers contact if they have questions?
If providers have questions, they can email:
- Questions related to rates to Rates@PartnersBHM.org.
- Questions related to claims to ClaimsDepartment@PartnersBHM.org.
Updated: