--- title: "Unlocking PHP Incentives in 2025–2026: What NC Practice Managers Need to Know Now" description: Beginning in January 2026, NC Medicaid will roll out the new AMH Standardized Performance Incentive Program, replacing the patchwork of PHP‑specific incentive structures with a single, statewide quality model. This means every PHP—AmeriHealth Caritas, Healthy Blue, WellCare, UnitedHealthcare, and Carolina Complete Health—will use the same quality measures, attribution rules, performance targets, and payment methodology. The shift is intended to reduce administrative burden, bring consistency to value‑based payment, and ensure that practices can focus on quality improvement rather than navigating five different sets of rules. Between now and launch, practices should review the draft policy guide, update workflows to align with the upcoming AMH measure set, and partner with AHEC coaches to ensure care teams, reporting processes, and data systems are ready. Preparing in 2025 will position your practice to fully benefit from the new statewide model—and maximize incentive earnings from day one of the 2026 performance year. --- [Practice Support Services](https://go.northwestahec.wakehealth.edu/practicesupport) # [Unlocking PHP Incentives in 2025–2026: What NC Practice Managers Need to Know Now](https://go.northwestahec.wakehealth.edu/practicesupport/unlocking-php-incentives-in-2025-2026-what-nc-practice-managers-need-to-know-now) Written by [Practice Support Team](https://go.northwestahec.wakehealth.edu/practicesupport/author/practice-support-team) | Jan 29, 2026 2:57:49 PM # 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** | PHP | Program Name | Incentive Type | Annual Cap | Notes | | --- | --- | --- | --- | --- | | **Healthy Blue** | Healthy Rewards | Gift-card rewards for screenings, visits, maternity activities | **$75/yr** | Strong alignment with AMH measures; broad activity list | | **AmeriHealth Caritas NC** | CARE Card | Gift-card rewards for WCVs, prenatal/postpartum, screenings | **$75/yr** | Clean structure; strong maternal incentives | | **Carolina Complete Health** | My Health Pays® | Gift-card rewards for WCVs, screenings, maternity | **$75/yr** | Strong infant visit incentives and broad screening rewards | | **WellCare of NC** | My Health Pays® | Gift-card rewards plus bonus maternity items | **$75/yr** | Most categories; only PHP with BH incentives & bonus baby gear rewards | | **UnitedHealthcare Community Plan** | No formal incentive program | Provides benefits (not tied to completing visits) | **N/A** | Benefits include baby items, food boxes, doula, gym memberships; not tied to care gap closure  | ### **2. QI‑Relevant Comparison Across All Five PHPs** ### **A. Well‑Child Visits (WCV) & Immunizations** | PHP | WCV Incentives | Immunization Incentives | | --- | --- | --- | | **Healthy Blue** | Yes – includes child and adult wellness visits  | Yes – IMA and flu | | **AmeriHealth** | Yes – $50 WCV (3–21 yrs) [\[wpcdn.ncqa.org\]](https://wpcdn.ncqa.org/www-prod/FINAL_NC-_NCQA-Webinar_1.30.25.pdf) | No specific immunization reward noted | | **Carolina Complete Health** | Yes – $25 child WCV; $50 for all 6 infant visits  | Flu: $25 | | **WellCare** | Yes – up to 6 infant visits, 2 toddler visits, annual age 3–21 visits | Flu: $25–$50; HPV incentive | | **UHC** | **No incentives** for WCV | **No incentives** for 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)** | PHP | Prenatal | Postpartum | Notes | | --- | --- | --- | --- | | **Healthy Blue** | Yes (prenatal visits rewarded) | Yes | Good alignment w/ AMH | | **AmeriHealth** | $35 prenatal visit  | $40 postpartum | Strongest amounts | | **Carolina Complete Health** | $25 NOP | $25 postpartum |   | | **WellCare** | $25 prenatal; $25 postpartum; **bonus baby item** (stroller, car seat, etc.) | $25 | Best engagement potential | | **UHC** | No reward‑for‑visit system | No reward | But: doula, baby items worth $ | **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)** | PHP | Diabetes A1c | Cancer screening | Notes | | --- | --- | --- | --- | | **Healthy Blue** | Yes (A1c) | Cervical & breast cancer |   | | **AmeriHealth** | Yes (diabetes bundle)  | Not specified |   | | **Carolina Complete Health** | $25 diabetes bundle; $25 mammogram & colonoscopy  | Yes | Strongly aligned | | **WellCare** | $25 A1c; $25 cervical, $25 mammogram, $25 colonoscopy | Yes | Most comprehensive | | **UHC** | **No screening incentives** | **No screening incentives** |   | **QI takeaway:** ➡ **WellCare** and **CCH** best for closing screening gaps. ### **D. Behavioral Health Follow‑Up** | PHP | BH incentives? | Details | | --- | --- | --- | | **Healthy Blue** | No | — | | **AmeriHealth** | No | — | | **Carolina Complete Health** | No | — | | **WellCare** | **Yes** | $25 for BH follow-up after hospitalization / antipsychotic prescription | | **UHC** | No incentive program | Offers virtual BH supports (not tied to rewards)  | **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](https://www.healthybluenc.com/medicaid/extras/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](https://www.amerihealthcaritasnc.com/member/benefits/carecard)** **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®](https://www.carolinacompletehealth.com/members/medicaid/resources/benefits-services/healthy-rewards-program.html)** **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®](https://www.wellcarenc.com/members/medicaid/benefits/my-health-pays.html)** **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 —](https://www.uhc.com/communityplan/north-carolina/plans/medicaid/medicaid-uhc-community-plan)**[***No Incentive Program***](https://www.uhc.com/communityplan/north-carolina/plans/medicaid/medicaid-uhc-community-plan) **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* [View full post](https://go.northwestahec.wakehealth.edu/practicesupport/unlocking-php-incentives-in-2025-2026-what-nc-practice-managers-need-to-know-now) ```json { "@context" : "http://schema.org", "@type" : "BlogPosting", "author" : { "@type" : "Person", "name" : "Practice Support Team" }, "dateModified" : "2026-01-29T14:57:49.317Z", "datePublished" : "2026-01-29T14:57:49Z", "headline" : "Unlocking PHP Incentives in 2025–2026: What NC Practice Managers Need to Know Now", "image" : { "@type" : "ImageObject", "height" : 1024, "url" : "https://7413846.fs1.hubspotusercontent-na1.net/hubfs/7413846/Designer-1.png", "width" : 1536 }, "mainEntityOfPage" : "https://go.northwestahec.wakehealth.edu/practicesupport/unlocking-php-incentives-in-2025-2026-what-nc-practice-managers-need-to-know-now", "publisher" : { "@type" : "Organization", "logo" : { "@type" : "ImageObject", "height" : 60, "url" : "/hs/hsstatic/content_shared_assets/static-1.4092/img/default-amp-logo.png", "width" : 60 }, "name" : "Practice Support Update Blog" } } ```