North Carolina's 1115 Waiver Approval: What It Actually Changes for MTM Providers

CMS formally approved North Carolina's Section 1115 waiver this week, authorizing MTMs and produce prescriptions for approximately 480,000 high-risk Medicaid beneficiaries over five years.

The key policy shift that operators should understand: the produce prescription eligibility definition removes the prior hospitalization requirement — a provision that has constrained programs in other states.

What This Means Operationally

For MTM providers already operating in NC, this creates a clear billing pathway under the NC DHHS-managed care framework. For those considering expansion, the waiver's evaluation framework (partnered with Duke University) will generate peer-reviewed evidence that could accelerate federal permanent coverage discussions.

Questions for the Community

1. Has anyone begun the contracting process with NC managed care plans under this waiver?
2. What documentation requirements are MCOs applying for produce Rx eligibility?
3. How are providers handling the ESRD and cancer diagnosis verification requirements?