MedicaidCoverageMedium impact
Some Qualified Medicare Beneficiaries Now Have Coverage for Family Planning Services
NC Medicaid - NCDHHS·NC · OB-GYN, Family Medicine, Internal Medicine +1 more·Medical Policy
We identified it
Jul 22, 2026
Summary
NC Medicaid Direct has expanded coverage for Qualified Medicare Beneficiary (MQB-Q/B) individuals to now include Family Planning services—contraception, health screenings, STI testing/treatment, lab services, HPV vaccines, and sterilization procedures—in addition to their existing premium and cost-sharing coverage. Providers must verify eligibility in NCTracks and inform eligible patients of this new benefit.
Action Required
Immediately: (1) Billing team must update NCTracks verification procedures to confirm MQB-Q and MQB-B beneficiary status and note Family Planning eligibility at point of service. (2) Front desk/intake staff should add screening question to patient registration to identify MQB-Q/B patients. (3) Providers and clinical staff must inform eligible MQB-Q/B patients about new Family Planning coverage during visits. (4) Update billing system to properly route Family Planning service claims for MQB-Q/B beneficiaries. (5) Educate billing staff that MQB-E (QI1) beneficiaries are NOT eligible for Family Planning coverage and should not be billed for these services. Reference NCTracks Call Center (800-688-6696) for eligibility verification questions. Failure to properly verify and apply coverage will result in claim denials or patient balance issues.