North Carolina Expands Medicaid Managed Care to Encompass Behavioral Health, I/DD Populations
North Carolina has reached a major milestone in Medicaid transformation, launching tailored plans on July 1, 2025, that bring Medicaid managed care to more than 210 000 enrollees with behavioral health needs or intellectual and developmental disabilities (I/DD). The state’s Department of Health and Human Services (DHHS) confirmed the long-anticipated rollout after years of delay due to network and technical readiness.
The tailored plans shift these complex populations into managed care, where their services—both behavioral and physical—are integrated under 4 regionally assigned plans. These plans contract with DHHS to deliver primary care, specialty services, and long-term support for individuals with significant needs. For providers and payers, this transition marks a significant opportunity to address fragmented care.
“This is another critical milestone in our work to build a stronger, more outcomes-oriented and accessible behavioral health system for North Carolina,” said Health Secretary Kody Kinsley.
While the state transitioned most Medicaid enrollees to managed care in 2021, implementation for this high-need population was repeatedly postponed. A December 2022 launch date was pushed back to address challenges with provider readiness and coordination requirements among local behavioral health organizations.
Key considerations for payers include the need for network compliance, as providers must now coordinate with plan networks for covered services, which could impact referral pathways and claims processing. Additionally, there is a risk of coverage gaps; enrollees who qualify for tailored plans but choose to opt out may forgo access to services that are not available under standard Medicaid managed care. Finally, carve-outs remain a factor, with approximately 587 000 enrollees still outside of managed care. This group includes dual eligibles, certain adults with disabilities who receive community-based support, and individuals receiving limited-benefit coverage.
This development further aligns the state with value-based care models, emphasizing whole-person care and fiscal sustainability. As North Carolina’s Medicaid enrollment surpasses 3 million—bolstered by 2023 expansion—tailored plans signal a new phase of integration for vulnerable populations.
Reference
North Carolina Medicaid managed care extended further starting this week. Associated Press. July 2, 2025. Accessed July 10, 2025. https://apnews.com/article/north-carolina-medicaid-disabilities-mental-health-804fb9ac8d78fd4624f2e0214a5abfab
