The Department of Health and Human Services (DHHS) is the single state agency responsible for the Medicaid Program and must operate within federal guidelines. DHHS has broad flexibility to manage the Medicaid Program and has delegated Medicaid administrative functions to the Division of Medical Assistance, other DHHS divisions and offices, other state agencies, and local government agencies. Based on experiences in other states, options exist for changing the organizational structure of the North Carolina Medicaid Program including a Department of Medicaid, a Medicaid Program Authority, and a Department of Health Services. Creating a new Medicaid agency in North Carolina has implications for the Medicaid Program, DHHS, and statewide business functions and would require a 12 to 18 month transition period.