Carolina Medical Home Network Preferred Payor Arrangement

The Carolina Medical Home Network (CMHN) has released its request for proposal (RFP) to identify aligned Medicaid health plans to pursue value-based agreement terms that meet the specific needs of federally qualified health center (FQHC) and the complex patients they serve. The RFP focuses on transparency, efficiency and optimizing disease prevention and reducing the burden of chronic disease for members across the state. The RFP represents the launch of CMHN’s Preferred Payor Arrangement (PPA) Initiative.

PPA Features and Goals: Since the launch of Medicaid managed care in 2021 and Medicaid expansion in 2023, the relationship between Medicaid’s Prepaid Health Plans (PHPs) and North Carolina’s FQHCs has continued to grow. CMHN’s member FQHCs provide vital services to over 125,000 Medicaid beneficiaries. At any point in time, North Carolina’s FQHCs ensure healthcare for between 5-10% of Medicaid’s Standard Plan members.

CMHN is offering all NC Medicaid PHPs an opportunity to be a preferred plan by achieving the following mutually beneficial goals:

1. Simplify contracting and reduce administrative burdens for FQHCs.
2. Aligning incentives based upon a discrete set of quality measures to allow focused interventions
   for prevention and chronic disease
3. Achieving network adequacy and patient access for NC residents in every corner of the state
   including our most rural communities
4. Ensuring sustainability of rural providers to provide integrated primary care, behavioral and oral
   health care
5. Advancing enhanced access to health and wellness for hard-to-reach populations
6.  Improving the value of Medicaid spending while improving member outcomes and quality of life

Timings: The PPA RFP was released on Wednesday, April 16, 2025.

PHP responses are expected no later than June 13, 2025 with plans for CMHN to announce its selected panel of Preferred Payors by August 15, 2025.

Payor contract negotiations are expected to be completed no later than October 31, 2025 so that CMHN’s network will be ready to serve Preferred Payor patients on January 1, 2026.

About CMHN: Carolina Medical Home Network is a clinically integrated network comprised of 26 federally qualified health centers serving Medicaid and Medicare patients across the state of North Carolina. CMHN currently holds payor contracts with all current Medicaid prepaid health plans.

Contact: Randy Jordan, Interim Director, jordanr@ncchca.org

CMHN Preferred Payor Arrangement Request for Proposals