January 9, 2026
Earlier this week, the NCDHHS issued updated physician fee schedules for Medicaid that will implement the reversal of the Medicaid rate cuts announced in December. As part of NCAFP’s advocacy against the cuts that were implemented on Oct. 1, our organization participated in a lawsuit which ultimately led to the state’s decision to reverse the cuts. Now the state and Medicaid Managed Care plans are tasked with implementing the updated fee schedules and paying the increased rate for claims that were processed while the cuts were taking effect.
According to a new fact sheet from NC Association of Health Plans (NCAHP), “Any outstanding recoupment related to the October 1 fee schedule changes have been cancelled effective immediately.” Health plans now have at most 45 days to implement the new fee schedules into their payment systems. From there, plans must go back and pay past claims at the higher pre-cut rate within 30 days from the time that the new fee schedules are implemented. Plans are hoping to implement the changes even sooner.
For 98% of claims, practices won’t have to do anything. Plans will pay practices the difference between the reduced rate and the increased rate now in place. As the process moves forward, the NCAFP will continue to share more information with our members.
The North Carolina Academy of Family Physicians, Inc. (NCAFP) is a nonprofit professional association headquartered in Raleigh which represents over 4,300 family physicians, family medicine residents, and medical students across the state. It is the largest medical specialty association in North Carolina and is a constituent chapter of the American Academy of Family Physicians, based in Leadwood, KS.
