July 2025

There’s a lot of uncertainty right now about what’s going to happen with Medicaid in our state. With proposed changes, shifting policies, and complex timelines, it’s difficult to know exactly what the future holds — and that can be frustrating for families, service providers, and advocates alike. In times like these, staying informed is essential. That’s why we’ve pulled together a few reliable ways you can keep up with the latest developments in Medicaid policy:

• NC Health News
• NC Council on Developmental Disabilities
• NC CHILD
• Disability Rights NC
• Hot Topics Newsletter from the Division of MH/DD/SUS



Medicaid Long Term Services and Supports (LTSS) Dashboard

More than 80,000 people in North Carolina use NC Medicaid Direct Long Term Services and Supports (LTSS) each month to get extra help with their health care. These services help people get care in their homes and communities instead of moving to a nursing home.

The LTSS Dashboard shows how people use these services. It includes data on:

• Personal Care Services (PCS)
• Community Alternatives Programs for:
• Children (CAP/C)
• Disabled Adults (CAP/DA)
• People moving from Medicaid Managed Care to NC Medicaid Direct
• Nursing home residents who are exploring home and community-based services
• Private duty nursing in both NC Medicaid Direct and NC Managed Care

See the LTSS Dashboard HERE

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From the NC Medicaid Ombudsman:

Medicaid pharmacy services, Medicaid copays, and resolving third party insurance problems

NC Medicaid Pharmacy Services:

• All health plans and NC Medicaid Direct follow the same pharmacy rules and NC Preferred Drug List 
• Each health plan is required to follow the same criteria when prior authorization (PA) is required to obtain medication
• Beneficiaries can fill their prescriptions at a pharmacy of their choice 
• Beneficiaries are not required to fill their medications at a single pharmacy unless they are enrolled in the NC lock-in program. 

Pharmacy Services Include:

• Some medicines sold without a prescription (also called “over the counter") like allergy medicines  
• Insulin and other diabetic supplies like syringes, test strips, lancets and pen needles  
• Smoking cessation agents, including over the counter products  
• Emergency contraception  
• Medical and surgical supplies, available through durable medical equipment pharmacies and suppliers  
• Health plans may offer some additional value-added services 

Important NC Medicaid Health Copay Information

A copay is a fee you pay when you get certain health care services and prescriptions. Under NC Medicaid all copays are $4.

A provider or pharmacist should not refuse service or prescriptions if a beneficiary cannot pay their copay at the time of service.

If beneficiaries have questions about copays, visit the copay webpage on the NC Medicaid at medicaid.ncdhhs.gov/about-nc-medicaid/nc-medicaid-copays, call the NC Medicaid Contact Center at 1-888-245-0179 or contact your health plan’s Member Services department at the number listed on the back of your health plan ID card. If they are unable to answer your question or fix the problem, contact the NC Medicaid Ombudsman at 1-877-201-3750.

Resolving Third-Party Insurance Problems

Sometimes when a beneficiary picks up a prescription at a pharmacy, they are told they have third-party insurance on file. This can be caused by an old insurance plan still on file or a data issue. Here are the steps to take to correct the problem:

• The beneficiary should call their health plan’s Member Services department at the number listed on the back of their health plan ID card to confirm the third-party insurance is shown in their system. If it is, the health plan may ask when the insurance ended. If the beneficiary does not know the end date, they can call the old plan to find out. Once the beneficiary gives their current health plan the old insurance plan’s termination date, the Member Services representative will submit a request to have the third-party insurance removed. Note, this may take up to 30 days.
• Beneficiaries should call their health plan’s pharmacy department to make sure they remove the third-party insurance from their system. A separate request is usually needed to remove the third-party insurance from the beneficiary’s account. Again, this may take up to 30 days.
• If a beneficiary needs to pick up the prescription immediately, ask the pharmacy department to request a prescription override. The override will last for 24 hours and allows the beneficiary to pick up the prescriptions (unless there is another problem).
• After the beneficiary talks with their health plan, they should call Health Management Systems (HMS) to make sure the third-party insurance was removed. The phone number is 1-866-262-2227, option 3. 
• If NC Medicaid Direct is your Medicaid program, this is all the beneficiary needs to do to have their third-party insurance removed. Their request should be completed within 24-48 hours, after that they should be able to pick up their prescriptions. If you are on a Tailored Plan, please contact HMS and follow up with your Tailored Plan after. 

If the problem is still not fixed after taking these steps, contact the NC Medicaid Ombudsman for help.

Community Partners Webinar – An Update on Medicaid

The Community Partners webinar series is designed to provide updates on NC Medicaid and key Medicaid initiatives.

Wednesday, July 30 from 3-4 p.m.

Click here to register

For more information or questions contact Medicaid.NCEngagement@dhhs.nc.gov 

Autism and Constipation Focus Group Opportunity

Virtually - Tuesday, August 5th from 7:00 - 8:30 pm

ECAC is proud to partner with researchers from Duke University and UNC-Chapel Hill on an important study exploring constipation in children and young adults with autism. We want to hear from families what potential outcomes of this study would be most important to families.

We are hosting two virtual focus groups, one in English and one in Spanish, to hear directly from:

• Parents and caregivers of children with autism who have experienced constipation, and/or
• Young adults with autism (ages 18+) who have or have had constipation issues.

Each participant will receive a $50 stipend for their time. Space is limited.

For more information or to sign up, please contact:

English: Christy Moore at cmoore@ecacmail.org

Spanish: Millie Ramos at mramos@ecacmail.org

Let your experience make a difference!

Inclusion Connects Advisory Committee Meeting

Inclusion Connects is an NCDHHS initiative to connect people with I/DD to more choices and more access to services and supports. The initiative is a collaboration among NCDHHS divisions, including the Division of Mental Health, Developmental Disabilities, and Substance Use Services and Medicaid, to provide resources for connecting individuals with I/DD to services and supports available to live, work and play in their chosen communities. Join the Inclusion Connects Advisory Committee meeting for updates on the progress of our programs and initiatives. This meeting is held quarterly on the third Monday of the month and is open to the public. Join this month for a review of the quarterly report and updates to the Innovations Waiver Waitlist Dashboard.

Date/Time: Monday, July 21, 2025, 2:00-3:00 p.m.

Join Link: Join the meeting



Disability Pride Month is celebrated every July to commemorate the signing of the Americans with Disabilities Act (ADA) on July 26, 1990. This month is intended to promote inclusion of people with disabilities and to ensure they are accepted exactly as they are and acknowledge they are a vital part of every community. The original Disability Pride flag was created by Ann Magill, who has cerebral palsy. It was developed to raise awareness and as a symbol of solidarity, acceptance and pride. In 2021 Magill collaborated with others to update the flag to be more accessible. Each color stripe represents a different group within the disability community: 

The diagonal stripes are set on a faded black background to symbolize mourning for those who have experienced neglect, violence, and death due to the disability. This flag also represents individuals cutting through darkness and barriers that separate them from society.  

Would Telehealth Be Helpful for Your Child's Care?

Are you interested in getting support with telehealth options for your child? If so, you and your child may be interested in joining the E-PRIME Study at Atrium Health Levine Children's. E-PRIME encourages telehealth use for pediatricians and provides support and resources for both them and the families they serve.

You and your child may be able to join if the child:

• Is younger than 18 years old
• has chronic health conditions
• Sees 4 or more sub-specialists OR uses special medical equipment (such as feeding tube, tracheostomy, oxygen, ventilator, etc.)
• Receives care from Levine Children's Hospital

Participating caregivers will be paid for the completion of surveys, with a chance to receive up to a maximum of $100 for the duration in the study. There is also an opportunity for caregivers to participate in an interview that will pay $30.

Upcoming Webinars

It's My Turn Training

It’s My Turn training is a self-determination curriculum for students with disabilities in middle school through high school. Students will learn about themselves, the choices they have, and becoming better self-advocates. https://courses.ocecd.org/courses/it-s-my-turn 

NeuroJourney is now available in English, Spanish, and French. We hope that with the addition of more language options, more parents caring for children with severe neurological impairment can find anticipatory guidance to support them along the way. Stay tuned as we work to roll out additional languages later this year.

Visit NeuroJourney.org to check out the three language options and enter the Clinician section where you can find informational sheets in all three languages to share with families and colleagues.

Work Together NC's Action Plan tool was recently enhanced with video examples of each action plan. The videos feature 3 different characters, Trey, Jayla, and Ash: each representing a different age and stage of the transition to adulthood. Customize an action plan for yourself or someone you support today!



New Respite Care Facility to open in Burgaw, NC

Henry’s House will be a dedicated respite care program for children ages 8 to 18 with Intellectual and Developmental Disabilities (I/DD), Autism, and Traumatic Brain Injury (TBI). Trillium Health Resources awarded Easterseals PORT Health $2,000,000 to renovate an existing facility to create Henry’s House for the well-being of children and families. Read More

 NC BRAINS - a Disability Rights NC Initiative   

DRNC’s NC BRAINS (Brain Resources and Injury Needs Screening) campaign is a public awareness campaign. NC BRAINS includes a web-based screening tool to assess the possible history of brain injury in any adult or child. Anyone in North Carolina is eligible to participate in this screening tool. NC BRAINS also includes options for providers across the state to request continuing training about brain injury. 

If you have a history of a head injury, know someone who has, or if you are a provider seeking more information, please check out their program!

The State Consumer and Family Advisory Committee (SCFAC) advises NCDHHS and the General Assembly on the planning and management of the Division of Mental Health, Developmental Disabilities, and Substance Use Services. The meeting is open to the public. Click here for more information.

Read the Summer Fun & Travel Issue of

EP Magazine

Summer presents unique opportunities and challenges for families raising children with disabilities. In EP’s annual Summer Fun and Travel Issue, we revisit some articles from recent years which address a variety of situations that parents will face during the upcoming weeks.

www.epmagazine.com



Give us a call at

1-800-962-6817

ECAC is providing this newsletter as a public service. Reference to any specific product or entity does not constitute an endorsement or recommendation by the ECAC. ECAC is not a legal services agency. We cannot and do not provide legal representation or advice, and information contained in this newsletter should not be used or considered as such. This newsletter is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $89,140 with 0 percentage financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov.