This week, our In Focus section reviews the Section 1115 waiver demonstration proposal submitted to the Centers for Medicare & Medicaid Services (CMS) on June 1, 2016, by North Carolina’s Department of Health and Human Services (DHHS). The waiver process was initiated by a state law passed in 2015, directing DHHS to redesign the Medicaid program around goals of quality, budgetary stability, and efficiency, including the development of a two-model statewide Medicaid managed care program. Under the submitted waiver, DHHS will contract with three statewide Medicaid health plans to operate alongside local health care provider-led managed care entities, scheduled to begin serving more than 1.5 million Medicaid beneficiaries in the summer of 2019.