Medicaid Managed Care Rate Reductions  

Medicaid rates received a reduction as of October 1, 2025.  Medicaid managed care rates are not exempt from these reductions.   

All five Standard Plans have agreed to the following implementation process:  

Effective Date: The revised fee schedules will be effective October 1, 2025, as required by NCDHHS. However, plans have up to 45 days to implement these changes and will use that flexibility to delay implementation until November 1.  

Implementation of Rate Reductions (November 1, 2025): All five Standard Plans will continue to pay claims at the previous rates through October. Reduced rates will take effect for claims paid on or after November 1, 2025.  

Recoupment: After implementation of the new fee schedules, plans will begin notifying providers of any overpayments for claims paid after the October 1 effective date.  

DHHS Action: If NCDHHS rescinds the rate reductions before November 1, plans will not proceed with implementation of the reduced fee schedules. This approach aligns the implementation timelines for both the Tailored Plans and Standard Plans, helping to simplify administration for providers. NCDHHS has indicated that plans will be required to recoup any overpayments made for dates of service on or after October 1.