The 2026 withhold, in plain terms
NC Medicaid withholds 2% of each Standard Plan's capitation and pays it back based on performance across 9 scored measure components in calendar year 2026.
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HRRN screening is now pay-for-performance. Screening members for health-related resource needs is scored against a goal, not just reported.
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Stratified measures carry real weight. Well-child visits and childhood immunizations are scored separately for Black/African American members, and together they make up 31.25% of the withhold.
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Full credit comes from closing 10% of the gap to goal. You don't have to hit the goal to earn the dollars back. You have to move.
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The measurement year ends December 31. Work that starts in November can still count this year, and it sets up 2027.
The Withhold Recovery Sprint
A 90-day, measure-focused engagement on one or two withhold measures.
Baseline and target (days 1–15)
your baseline, current rates and the exact gap-closure target for each measure
Root-cause analysis (days 16–30)
process mapping, care manager and provider interviews, member barriers
Intervene and track weekly (days 31–75)
workflow fixes, outreach scripts, care manager and provider training, and a weekly run chart.
Evaluate and hand off (days 76–90)
results against target, review-ready documentation and a 2027 plan
Investment
Investment: $22,500 for one measure over 90 days; $7,500 for each additional measure. Start by mid-November to act before the measurement year closes.
Why US
Get to Know Us
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Built from inside health plans. Dr. Deann Johnson has led quality, equity and training work at health plans and Medicaid organizations for 20+ years.
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Credentialed for quality work. CPHQ, CHC, DHA.
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Local. Based in Charlotte, with in-person working sessions available across North Carolina.Documentation that holds up. Every intervention is written up so it's ready for EQR review.
