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Yesterday, the North Carolina Division of Health Benefits (DHB) provided official notification to Vaya Health regarding changes to NC Medicaid fee schedule rates effective Oct. 1, 2025. For more information, review the NC Medicaid Bulletin.
While the notification provided an overview of the changes, Vaya has not yet received all the new detailed fee schedules required to update our systems. Our contracts with NC Medicaid require us to implement NC Medicaid and Vaya fee schedule changes within 45 days of written NCDHHS notification to Vaya or the actual posting of the detailed fee schedules, with an additional 30 days to reprocess all impacted claims with dates of service on or after the effective date of the change.
We have heard from providers asking us to postpone implementation of the DHB rate changes and allow more time for NCDHHS and the NC General Assembly to reach agreement on a path forward that would not include these rate cuts. After consulting with our fellow Behavioral Health and I/DD Tailored Plans, we have decided to update our systems to implement the fee schedule changes no earlier than Nov. 1, 2025. If there is no legislative agreement by Oct. 31, Vaya will implement the rate cuts on Nov. 1, retroactive to the effective date of Oct. 1. On that date, we plan to update our systems to pay at the newly published rates, and we will take steps to recoup the difference in reimbursement for services provided back to Oct. 1.
Providers should know that NC Medicaid is reducing the capitation rates of Vaya and the other managed care plans effective Oct. 1 to reflect the new fee schedules, and we do not have any funding or flexibility to postpone the cuts indefinitely unless action is taken at the state level to reverse the Department’s decision to implement provider rate reductions.
We understand the impact this may have on you, Vaya members, and the entire health care community. We were hopeful that fee schedule reductions would be avoided, and we continue to advocate for a solution that will stop these rate cuts from being implemented.
The Association of NC Public Community Health Plans is reaching out to provider associations to share this decision as soon as possible. We are still evaluating some of the nuances related to provider-specific (individual enhanced) rates, which could impact our final implementation, but we wanted to get this message out today to alleviate immediate concern. We will issue more detailed communication next week. If you have questions, please email provider.info@vayahealth.com or join Vaya’s Provider Touchpoint webinar from 11 a.m.-12 p.m. Oct. 3, 2025.
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