NC Medicaid Back Porch Chat: What Providers Should Know from May 2026

NC Medicaid’s May 2026 Back Porch Chat highlighted several updates that affect providers across the state, including new data tools, pharmacy benefit changes, and updates to care management programs. These sessions are designed to keep providers informed about program changes and resources that support care delivery.

Below is a summary of key updates and what they mean for your practice.

New TBI Dashboard Improves Access to Data

NC Medicaid introduced a new Traumatic Brain Injury (TBI) dashboard that provides a centralized, publicly accessible view of service use across the state.

What this means for providers:
The new TBI dashboard gives providers and partners clearer visibility into service use, helping support data-driven planning, advocacy, and care coordination.

The dashboard was developed in response to the need for more transparent and actionable data. It allows users to better understand who is accessing TBI services, what types of services are most commonly used, and how frequently those services are delivered.

This tool is intended to support a wide range of stakeholders, including providers, policymakers, advocates, and individuals with TBI and their caregivers. By making this information more accessible, the dashboard can help inform program planning and guide decisions about resource allocation across North Carolina.

New Pharmacy Benefit Administrator Transition Now in Place

NC Medicaid also shared updates about the transition to a new Pharmacy Benefit Administrator (PBA). Prime Therapeutics began serving in this role on May 2, 2026, and now processes all Medicaid Direct pharmacy point-of-sale claims.

Key takeaway:
While the claims processing system has changed, clinical policies and reimbursement remain under state control, and managed care pharmacy processes are not affected.

For providers, the transition is intended to simplify pharmacy-related processes while improving transparency and consistency in how pharmacy benefits are managed. Importantly, the state retains authority over clinical policies and reimbursement methodologies, which means core program rules remain unchanged.

Providers working with Medicaid Direct should be aware that pharmacy prior authorizations are now handled through Prime Therapeutics. However, there are no changes to pharmacy processes within Medicaid Managed Care plans, and providers should continue to follow their existing workflows for those patients.

Care Management Programs Extended Through 2026

NC Medicaid announced an extension for two longstanding care management programs: Care Management for At-Risk Children (CMARC) and Care Management for High-Risk Pregnancies (CMHRP). These programs support vulnerable populations including young children and pregnant individuals at higher risk for complications.

Important update:
Local Health Departments can continue providing CMARC and CMHRP services through December 31, 2026, ensuring continuity of care during ongoing program transitions.

Local Health Departments will continue to provide these services through December 31, 2026, extending the current arrangement by six months beyond the previously planned transition date. Existing payment structures and technology support will remain in place during this period.

Additional guidance is expected regarding how care management for these populations will be structured beginning in 2027, so providers should watch for future updates.

New Quality Measures Dashboard Supports Performance Improvement

NC Medicaid is also advancing efforts to make quality data more accessible through a new public-facing Quality Measures Dashboard. This tool is designed to help providers and stakeholders better understand performance across the Medicaid program.

Why this matters:
Providers can use the dashboard to compare performance, identify gaps, and support quality improvement efforts across patient populations.

The dashboard allows users to view and compare quality measures across managed care plans and explore results by demographic and geographic factors. By making this information easier to access and interpret, NC Medicaid aims to support continuous quality improvement and help identify opportunities to improve patient outcomes.

The measures included focus on key areas such as preventive care, chronic disease management, and follow-up after hospitalization, reflecting priorities that align closely with primary care and population health efforts.

Why These Updates Matter for Providers

Taken together, these updates reflect a continued focus on transparency, data-driven decision-making, and coordinated care. New dashboards provide greater visibility into both service use and quality outcomes, while program updates aim to reduce disruption and maintain continuity of care for vulnerable populations.

For providers, these changes offer new tools to support clinical decision-making and population health management, while also reinforcing the importance of staying current with evolving Medicaid processes and requirements.