Update on Care Coordination for High-Risk Pregnant Women and At-Risk Children

This bulletin summarizes the content of the programmatic guidance document for Care Coordination for High-Risk Pregnant Women and At-Risk Children.

This bulletin applies to NC Medicaid Managed Care and NC Medicaid Direct.

NC Medicaid has released a programmatic guidance document for Care Coordination for High-Risk Pregnant Women and At-Risk Children. The purpose of the guidance document is to provide updated and clarifying information to Medicaid providers regarding the Department’s vision for transitioning the current State Plan Services of Care Management for High-Risk Pregnancies (CMHRP) and Care Management for At-Risk Children (CMARC) into managed care authority as part of a final transition to whole-person care being provided by Prepaid Health Plans.

In response to a large volume of questions and to prevent confusion across providers, the Department developed this guidance draft to outline its expectations for health plans and the PCCM entity in serving the members transitioning from the CMARC/CMHRP services previously provided mostly by Local Health Departments.

The guidance document provides an overview of changes proposed for the upcoming transition effective Jan. 1, 2027. The overview includes:

• Referrals During the Transition Period
• Specialized Care Coordination Functions
• Key Requirements Effective Jan. 1, 2027, for Pregnant Women Identified as High Risk
• Key Requirements Effective Jan. 1, 2027, for Children Identified as High-Risk Children
• Understanding the Interaction of the proposed Specialized Care Coordination Functions with Existing Care Management/Care Coordination Requirements in NC Medicaid.

Resources

The guidance document is also available on the Care Management for High-Risk Pregnancies (CMHRP) webpage and the Care Management for At-Risk Children (CMARC) webpage.