NC Senate Bill 257 · Section 9E.23 · Supplier Exposure Tool

The floor under your Medicaid rates expires June 30, 2029.

Since managed care launched in 2021, North Carolina law has required health plans to pay DME, orthotics, and prosthetics suppliers 100% of the lesser of the supplier’s usual and customary rate or the maximum allowable Medicaid fee-for-service rate. The Current Operations Appropriations Act of 2026 (S.L. 2026-41) extends that protection, but only through June 30, 2029. Five months later, on December 1, 2029, every plan begins a new contract cycle carrying statutory cost-containment mandates. Rate protection ends in the same period that the next five years of rates are negotiated. This tool estimates what that window means for your book of business.

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days until the §9E.23 rate floor expires
as of

Estimate your exposure

Three inputs. Your numbers stay on this page. Nothing is stored or transmitted.

Annual NC Medicaid managed care revenue — DME, supplies, orthotics & prosthetics ($) Revenue currently protected by the 100% fee-for-service floor.

Gross margin on that revenue (%) Revenue minus product/direct cost. Industry-typical for CRT runs well under 40%.

Post-floor scenario: plan-negotiated rates as a share of today's fee-for-service benchmark Illustrative scenarios — not predictions. Move the slider to stress-test.

deeper cut ◀ 90% of FFS ▶ floor held

Your exposure

Annual revenue at risk $200,000

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Cumulative exposure across the first post-floor contract cycle (Dec 2029 – Nov 2034, flat volume)

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Your current annual gross profit on this book of business

Share of that gross profit consumed by the rate cut

Get the branded one-page Exposure Summary

The on-screen numbers are a starting point. The one-page summary, which I prepare myself, adds:

Side-by-side scenario table (95 / 90 / 85 / 80) for your figures
The full 2029 Convergence timeline: floor expiry, rebid, cost-containment and accreditation mandates
The readiness sequence: what suppliers who intend to negotiate rates, rather than accept them, start doing in 2027

Opens a pre-addressed email from you to 5Q Health with your inputs attached. You send it yourself. There is no hidden tracking, and you will not be added to a mailing list.

Model card: what this tool is and is not

5Q Health advises organizations on accountable AI and algorithmic decision systems. We hold our own tools to the standard we hold everyone else's: every 5Q tool ships with a plain-language statement of scope, limits, and data handling.

What it does

Applies simple, inspectable arithmetic to numbers you enter: revenue × (100% − scenario rate)
Shows margin leverage: how a rate cut affects gross profit as well as revenue
Uses statutory dates from S.L. 2026-41 §§9E.17, 9E.21, 9E.23, verified against the chaptered session law

What it does not do

Predict actual post-2029 rates; scenarios are illustrative stress tests, not forecasts
Model volume changes, payer mix shifts, network exclusion, or category-level rate variation
Provide financial, legal, or investment advice; it is an educational estimate for planning conversations

Your data: all calculation happens in your browser. Nothing you type is stored, transmitted, or tracked by this page. The only way your figures reach 5Q Health is if you choose to send them by email. Legal status: provisions cited are from the Current Operations Appropriations Act of 2026, Session Law 2026-41 (SB 257, approved July 7, 2026) §§ 9E.17, 9E.21, and 9E.23, verified against the chaptered text on September 26, 2026.