Medicaid Report Card › State Rankings › North Carolina
Medicaid Report Card — State Snapshot
North Carolina
Overall rank
#48
of 50 states
Total score
28
out of 100
North Carolina performs moderately on MCO presence, private coverage retention, per-enrollee cost growth, improper payment performance, and APCD activity. On the other hand, North Carolina’s overall score is constrained by Medicaid expansion, no early work requirement activity, weak redetermination performance, weak MFCU enforcement activity, active CON laws, limited provider flexibility, and high Medicaid budget exposure.
Strengths
MCO presence
Moderate private-to-Medicaid coverage ratio
Moderate per-enrollee cost growth and improper payment score
Some APCD activity and IMLC participation
Weaknesses
Medicaid expansion
No early work requirement activity
Weak redetermination performance
Active CON laws and limited provider flexibility
At a glance
Quick facts
Expansion statusAdopted
Work requirementsNo
Redetermination rate85.1339% (Q5)
5-yr spending growth4.89% (Q4)
Per-enrollee cost growth1.22% (Q3)
Medicaid budget share18.7% (Q4)
Improper payment rate3% (Q3)
MFCU enforcement0.22 (Q1)
Score breakdown
Points by pillar
Program design & enrollment7/36
Fiscal sustainability & cost growth8/26
Program integrity & oversight8/24
Market structure & provider environment5/14
Total score 28 / 100
Pillar scores & metrics
Pillar 1
Program Design & Enrollment
7/36
Expansion status
Adopted 0
Work requirements (early activity)
No 0
Redetermination rate (lower = better)
85.1339% Q5 0
MCO presence
Yes 4
Coverage ratio (higher = better)
84.4923% Q3 3
Pillar 2
Fiscal Sustainability & Cost Growth
8/26
5-year spending growth (lower = better)
4.89% Q4 2
Per-enrollee cost growth (lower = better)
1.22% Q3 4
Medicaid budget share (lower = better)
18.7% Q4 2
Pillar 3
Program Integrity & Administrative Oversight
8/24
Improper payment rate (lower = better)
3% Q3 6
MFCU enforcement strength (higher = better)
0.22 Q1 0
APCD status
Strong Interest 2
Pillar 4
Market Structure & Provider Environment
5/14
Certificate-of-Need laws
Active CON Law 0
Primary care provider supply (higher = better)
316.6/100k Q3 2
NP scope of practice
Supervision Required 0
PA scope of practice
Advanced 1
IMLC participation
Member State 2
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