Children and Families Specialty Plan
Set to Launch December 1, 2025
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The Children and Families Specialty Plan (CFSP) is a first-of-its-kind statewide health plan to ensure access to comprehensive physical and behavioral health services for NC Medicaid-enrolled children, youth and families currently and formerly served by the child welfare system with seamless, integrated and coordinated care.
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The first CFSP contract was awarded to Blue Cross Blue Shield NC after a competitive selection process, and the term will last four years. The plan, named Healthy Blue Care Together (HBCT), will go live on Dec. 1, 2025.
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Over the past several months, NCDHHS has worked closely with HBCT to ensure readiness for launch. This includes building a strong provider network, onboarding staff and care managers, and putting systems in place to support quality care. HBCT has their own provider contract template and process, making it imperative for providers serving impacted beneficiaries to initiate contact.
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Providers should review the Fact Sheet for more information about impacted Medicaid beneficiaries, key dates, and contracting.
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For additional information about CFSP, please visit the Children and Families Specialty Plan webpage.
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Refresher:
How to Confirm Medicaid Coverage for Beneficiaries
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A recently released bulletin provides steps and an overall refresher on how to confirm Medicaid coverage for beneficiaries
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North Carolina Providers and pharmacies should always use NC Tracks to confirm Medicaid eligibility for patients. Although health plans are required to generate an identification card that contains the beneficiaries’ NC Medicaid Identification number, member ID cards are not required at time of visit to render services. Therefore, it is very important for Providers and pharmacies to verify eligibility, health plan assignment, and primary care provider enrollment using the NC Tracks Recipient Eligibility Verification/Response system.
This point of verification provides a good time to review patient assignments and overall provider attribution allowing for reconciliation. If not already assigned, and the patient would like to change their PCP to your practice, please access the Provider Change forms based on the health plan coverage to facilitate the request.
The Standard PHP Plans (SPs) have updated their PCP Change Forms. These forms may be submitted when a member requests to change their Primary Care Provider (PCP), or if an established patient within your clinical care is not assigned to the practice by the covered PHP, thereby adding the member to the Provider’s panel for attribution purposes. In response to Provider feedback, the forms have been revised to allow PCPs to attest to verbal member consent in cases where a written signature cannot be obtained. Below are the links to each SP’s updated form:
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Coding Corner:
Health Plans Continue to Cover
ACIP-Recommended Immunizations
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AHIP, the national trade association that represents the health insurance industry, recently issued the following statement regarding all vaccines that were ACIP-recommended as of September 1, 2025
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“Health plans are committed to maintaining and ensuring affordable access to vaccines. Health plan coverage decisions for immunizations are grounded in each plan’s ongoing, rigorous review of scientific and clinical evidence, and continual evaluation of multiple sources of data.
Health plans will continue to cover all ACIP-recommended immunizations that were recommended as of September 1, 2025, including updated formulations of the COVID-19 and influenza vaccines, with no cost-sharing for patients through the end of 2026.
While health plans continue to operate in an environment shaped by federal and state laws, as well as program and customer requirements, the evidence-based approach to coverage of immunizations will remain consistent.”
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Regulatory Reminders:
Cold Chain On the Move: Be Ready Before the Storm!
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Hurricane season is still in effect and ends on November 30. During hurricane season, healthcare organizations must proactively safeguard vaccine inventory. This includes preparing for power outages, flooding, and facility evacuations. The NC Department of Health and Human Services (NC DHHS) provides guidance for vaccine management
during emergencies.
Additional Resources:
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Reminder:
NC Medicaid Provider Ombudsman
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The Division of Health Benefits (DHB) has created a Provider Ombudsman to represent the interests of the provider community by receiving and responding to inquiries and complaints regarding PHPs. The Ombudsman will provide resources and assist providers with issues through resolution.
The Provider Ombudsman continues to be an available resource. However,
it is separate from the managed care health plans’ issue resolution processes and should be used only after contacting the health plan(s) or seeking information and guidance through the
NC Medicaid Help Center.
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SPICE North Carolina Infection Control Course:
Outpatient Healthcare Setting
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In North Carolina, every healthcare organization that performs invasive procedures, including injections, is required to designate an on-site staff person to receive infection control training and implement an infection control program.
If you do not have a designated on-site staff member who has received training or if your team needs a refresher, sign up for
SPICE North Carolina Infection Control Course: Outpatient Healthcare Setting Wake AHEC will be offering this live webinar on March 6, 2026.
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The NC AHEC 8th Annual Statewide Celebration of Rural Nursing Conference is scheduled for November 14 from 8:30 AM – 1 PM. This year, we will be hosting a live webinar event with the theme "Silent Struggles, Strong Voices: Advocating for Patients and Families."
Rural nurses are the often-unseen pillars of their communities—responding not only to medical needs, but also to deeply rooted social challenges. Silent Struggles, Strong Voices is designed to elevate and empower rural nursing professionals as they confront the silent epidemics affecting patients and families.
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Practice Support Newsletter?
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Helping You Meet the Challenges!
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