NC Medicaid 1115 Waiver Evaluation 2021-2026


Background on the 1115 Waiver:

The State of North Carolina is transitioning the Medicaid and NC Health Choice programs from fee-for-service models to managed care.  The transition to managed care will be paired with initiatives to:

(a) support and enhance the capabilities of Medicaid providers;

(b) strengthen access to care for beneficiaries; and

(c) improve health through evidence-based, health-related interventions spearheaded by public–private regional pilot programs (collectively the “ECM Pilot Program,” also known as “Healthy Opportunities Pilots”).

NC received approval of a 1115 demonstration waiver to implement these initiatives and complete the transition to managed care.

Background on the Evaluation:

Federal law requires 1115 demonstration projects be evaluated by an external, independent entity. North Carolina selected the Sheps Center to perform the required evaluation components:

(a) An evaluation of the Department’s 1115 Waiver

(b) An evaluation of the ECM Pilot Program/Healthy Opportunities Pilots

(c) A provider satisfaction survey.