Unlocking PHP Incentives in 2026: What NC Practice Managers Need to Know Now

January 28, 2026 — Practice Support Team

North Carolina’s Medicaid environment is shifting rapidly — and with those changes come new opportunities for practices to strengthen quality performance, support patient outcomes, and secure incentive‑based reimbursement. Whether your practice works with AmeriHealth Caritas, Healthy Blue, WellCare, UnitedHealthcare, or Carolina Complete Health, understanding both the current incentives and the upcoming 2026 standardized model is essential.

This post brings together key details from the major PHP programs — including Healthy Blue’s Healthy Rewards Program — along with insights from NC AHEC practice support coaches across the state. Our goal is simple: Help your practice claim every dollar it’s eligible for in 2026.

Why Incentives Matter More Than Ever

Medicaid PHP incentives directly support two major goals:

• Improving quality and outcomes by encouraging completion of evidence‑based preventive and chronic‑care services.
• Strengthening practice sustainability through reimbursement tied to performance and measurable care gaps closed.

One example is Healthy Blue’s Healthy Rewards Program, where members earn incentives for completing priority services such as:

• Prenatal and postpartum care
• Well‑child visits (0–30 months and 3–20 years)
• Breast, cervical, and colorectal cancer screening
• Diabetes A1c testing
• Immunizations
• Dental visits
• Tobacco cessation counseling
• Asthma medication adherence

When your practice completes these services and submits timely claims, patients earn rewards — and your practice earns quality credit and incentive payments.

What’s Changing in 2026 — and Why Preparation Matters

Beginning in 2026, NC Medicaid will implement the new Standardized AMH Performance Incentive Program. This statewide model will:

• Use one statewide set of AMH quality measures
• Standardize attribution and payment methodology
• Align performance periods and reporting timelines
• Eliminate PHP‑specific variations that burden practices
• Simplify workflows for multi‑plan practices

This new model will simplify your work — but only if your practice prepares before the 2026 performance year begins.

Insights From NC AHEC Practice Support Coaches

Across NC AHEC regions, practice support coaches continue to hear the same themes:

1. Practices want clarity as Medicaid rules evolve.

Coaches help translate changing guidance, sharing up‑to‑date measure specifications and actionable workflows.

2. Practices that align workflows early see stronger results.

Teams that adjust scheduling, documentation, and billing processes early consistently outperform late adopters.

3. Many practices don’t realize they’re missing out on incentives.

AHEC coaches frequently uncover unclaimed incentive opportunities during dashboard reviews or chart audits.

4. Practices that partner with AHEC early adapt more smoothly.

Coaches help practices translate policy into practical workflows — from interpreting 2026 measures to troubleshooting billing issues.

Action Steps for NC Practice Managers

Here’s what your practice should begin doing now:

1. Review all PHP incentive programs and align workflows.
   Confirm staff understand which services are incentivized and how to document them correctly.
2. Submit claims promptly.
   Incentive payments and quality credit depend on timely, accurate submission.
3. Educate patients about available rewards.
   Engaged patients complete more visits and help close more care gaps.
4. Prepare staff for the statewide 2026 program.
   Design your strategy to adopt unified documentation and coding processes.
5. Use your data.
   If you're unsure how you're performing, AHEC coaches can help review dashboards, attribution reports, or claims histories.

NC Medicaid PHP Patient Incentive Program Comparison (2026)

Including Healthy Blue, AmeriHealth, Carolina Complete Health, WellCare, and UnitedHealthcare

This comparison highlights:

• Whether each PHP has a real incentive program
• The reward model
• Reward amounts
• Annual caps
• QI‑relevant categories (WCVs, maternity, screenings, chronic disease, behavioral health)

To make differences crystal clear, each PHP has its own color‑coded box and summary.

1. Side‑by‑Side PHP Summary Table

2. QI‑Relevant Comparison Across All Five PHPs

A. Well‑Child Visits (WCV) & Immunizations

QI takeaway:
➡ WellCare and Carolina Complete Health offer the strongest WCV incentives.
➡ UHC has none (requires alternative engagement strategies).

B. Maternal Health (Prenatal & Postpartum)

QI takeaway:
➡ AmeriHealth = highest prenatal/postpartum dollar amounts.
➡ WellCare = strongest engagement due to bonus baby gear.
➡ UHC = best SDOH supports but no visit-based incentives.

C. Chronic Disease Screenings (Diabetes, Cancer)

QI takeaway:
➡ WellCare and CCH best for closing screening gaps.

D. Behavioral Health Follow‑Up

QI takeaway:
➡ WellCare is the ONLY PHP with BH visit incentives — big opportunity for closing FUH & APMH gaps.

3. PHP‑Specific Tip Sheets (Ready for Staff Use)

These are short, direct, and practice‑friendly.

📘 TIP SHEET: Healthy Blue — Healthy Rewards

Annual Cap: $75
Reward Format: Gift card via reward portal

Earns Rewards For:

• Prenatal & postpartum visits
• Adult wellness visits
• Child well visits
• Flu shot
• Diabetes A1c
• IMA adolescent vaccines
• Cervical cancer screening
• Follow-up after BH hospitalization
  (Some activities require self‑report)

QI Opportunities:

• Strong for WCV, maternity, diabetes, cervical cancer
• Good alignment with AMH & HEDIS

📘 TIP SHEET: AmeriHealth Caritas NC — CARE Card

Annual Cap: $75
Reward Format: CARE Card (OTC-style card)

Earns Rewards For:

• Annual well‑child visit (3–21 yrs): $50
• Adult preventive visit: $50
• Prenatal visit: $35
• Postpartum visit: $40
• Care Needs Screening: $25

QI Opportunities:

• Highest maternity dollar amounts
• Simple structure easy for staff to explain
• Great for postpartum outreach

📘 TIP SHEET: Carolina Complete Health — My Health Pays®

Annual Cap: $75
Reward Format: Visa prepaid card

Earns Rewards For:

• Child well care visits (2–20 yrs): $25
• Infant visit completion (6 visits): $50
• Adult well visit: $25
• Flu shot: $25
• Diabetes bundle (A1c, kidney, eye): $25
• Mammogram & colonoscopy: $25
• NOP form: $25
• Postpartum visit: $25

QI Opportunities:

• Strong infant well‑visit incentives
• Great for CRC, breast cancer, diabetes
• Simple postpartum incentive

📘 TIP SHEET: WellCare of North Carolina — My Health Pays®

Annual Cap: $75
Reward Format: Prepaid rewards card

Earns Rewards For:

Well‑Child:

• Infant visits (0–15 months): series completion
• Toddler visits (15–30 months): 2 visits
• Ages 3–21: annual WCV

Immunizations:

• Flu: $25–$50
• HPV: $25

Maternal:

• Prenatal: $25
• Postpartum: $25
• Bonus baby reward: stroller, playpen, car seat, diapers

Chronic Disease:

• Diabetes A1c: $25
• Cervical cancer: $25
• Mammogram: $25
• Colonoscopy: $25

Behavioral Health:

• $25 for FUH after hospitalization
• $25 for antipsychotic follow‑up

QI Opportunities:

• Best PHP for WCV, immunizations, chronic disease, and BH
• Bonus item is a huge motivator for prenatal engagement

📘 TIP SHEET: UnitedHealthcare Community Plan — No Incentive Program

Annual Cap: N/A
Reward Format: No reward‑for‑visit system

Offers Non‑Incentive Benefits:

• Baby items (car seat, pack‑and‑play, diapers)
• Doula support (up to $1,200 value)
• Fresh produce boxes (6 months)
• Post‑discharge meals (14 days)
• Youth sports program benefit ($75)
• Sensory store gift cards
• Gym memberships

QI Opportunities:

• Benefits can support visit adherence indirectly
• UHC members may need more direct outreach since no reward is tied to completing care gaps

Written by the Practice Support Team