MedicaidPrior AuthHigh impact
Children and Family Specialties Plan Policy Flexibilities to End June 30, 2026
NC Medicaid - NCDHHS·NC · Pediatrics, Family Medicine·Medical Policy
Effective date
Jul 1, 2026
We identified it
Jun 16, 2026
Summary
The Children and Family Specialties Plan (CFSP) in North Carolina is ending several temporary policy flexibilities on June 30, 2026, including relaxed prior authorization requirements for medical and pharmacy services, in-network payment rates for non-participating providers, and enhanced continuity of care provisions. Starting July 1, 2026, standard CFSP policies and authorization requirements will resume.
Action Required
Before July 1, 2026: Billing team must prepare for reinstatement of standard prior authorization requirements for CFSP members by updating billing system workflows to require medical and pharmacy PAs. Non-participating providers must prepare for reduced reimbursement rates as they will no longer be paid at participating provider rates. Review current CFSP patient roster and ensure proper network participation status. Contact Healthy Blue Care Together Provider Support at 833-777-3698 for specific authorization requirements that will take effect.