The North Carolina Department of Health and Human Services (NCDHHS) today published summary network adequacy results for Standard Prepaid Health Plans (Standard Plans) which were in effect for the July 1, 2021 “go-live." Network adequacy measures the ability of each NC Medicaid Managed Care health plan to deliver covered benefits by providing adequate access for members to all covered health care services through a network of contracted health care providers. Network adequacy and accessibility standards help verify that members have access to providers and offer an important tool for NC Medicaid to monitor and measure that access.

In NC Medicaid, network adequacy standards are either a maximum travel time or distance from a member’s residence to one or more providers of a certain type OR a minimum number of providers of a certain type within a geographic boundary (county or region). 

In advance of managed care launch, NC Medicaid focused on five priority-service groups and summarized network adequacy analysis results on a regional and county-by-county basis for those five categories of services – Primary Care, Hospitals, Pharmacy, OB/GYN, and Outpatient Behavioral Health for evaluation of the Standard Plans. 

The priority categories were chosen due to their potential impact on the member population. NC Medicaid decisions relating to participation in auto-enrollment and for managed care launch were partially based upon the plans’ performance in those priority provider/service groups.

Network adequacy results based upon network data submitted by the Standard Plans on July 12, 2021, and on Sept. 20, 2021, can be found on the Network Adequacy Oversight Measures and Results webpage.

For more information, please see the NC Medicaid Managed Care Health Plan Network Adequacy webpage.