The North Carolina Community Health Center Association (NCCHCA) reported some Federally Qualified Health Center (FQHC) sites were being suspended from Medicaid or losing their FQHC taxonomy based on how Medicaid was verifying Medicare participation by the FQHC. This disproportionately affected FQHC sites which do not typically enroll with Medicare (e.g., pharmacy, dental, and pediatric practices). Fortunately, NCCHCA and Medicaid have worked together to identify a solution.

Effective immediately, when verifying an FQHC’s participation in Medicare as a prerequisite for Medicaid enrollment or re-enrollment of a practice site under the FQHC taxonomy, NC Medicaid’s vendor GDIT will verify that an FQHC site meets the Medicare participation requirement if any site under the same FQHC organizational name and tax identification number is also enrolled in Medicare.

In effect, this this will allow confirmation based on the “parent” organization, without requiring that “child” sites or those typically serving non-Medicare populations or services to enroll in Medicare. This applies to reverification of existing FQHC sites as well as existing FQHC organizations adding new sites and locations.