Medicaid Managed Care
Changes are ahead for North Carolina's Medicaid program.
If you receive benefits under North Carolina’s Medicaid program, you should know about upcoming changes. Most enrollees must choose a health plan as the state shifts to managed care. Look for a letter from the state that tells you whether you are eligible for managed care.
Novant Health Medical Group participates in the following managed care plans:
- AmeriHealth Caritas NC
- Carolina Complete Health
- Healthy Blue
- UHC Community Plan
- WellCare of NC and Medicaid Direct
Five things to know about the state's new Medicaid program
NC Medicaid Managed Care helps you get the most out of your Medicaid benefits. Instead of one Medicaid program, you can choose from health plans.
- Each health plan has the same Medicaid services, such as office visits, blood tests and X-rays.
- Health plans may also offer added services such as programs to help you quit smoking, eat healthier and have a healthy pregnancy.
See a list of added services by health plan visit (PDF). Each plan has its own network of qualified doctors and healthcare professionals.
Your new health plan becomes effective July 1.
- Open enrollment (where you choose your plan and doctor) continues through May 14.
- If you do not choose a health plan and a doctor by May 14, one will be chosen for you beginning May 15.
- You have until Sept. 30 to change your health plan for any reason.
- Choose a primary care provider (PCP). Your PCP is your family doctor, clinic or health care provider. Your PCP will help you with your health care needs and coordinate your care with other health providers. Your primary care provider can be a doctor, physician assistant or nurse practitioner. If you want to keep your current PCP, choose a health plan your PCP works with. If you do not choose a PCP, your health plan will choose one for you. You can choose your primary care provider through the following options:
- Visit ncmedicaidplans.gov/.
- Use the NC Medicaid Managed Care mobile app.
- Call toll free 833-870-5500 (TTY: 833-870-5588).
- Choose a health plan. A health plan is a group of doctors, hospitals and other health care professionals that work together to give you the health care you need.
- Enroll in a plan. If you do not choose a health plan, one will be chosen for you.
- Chat with an enrollment specialist at ncmedicaidplans.gov.
- Use the NC Medicaid Managed Care mobile app.
- Call toll-free 833-870-5500 (TTY: 833-870-5588).
- Fill out and mail or fax in a paper enrollment form you’ll receive in the mail.
Watch a video that explains what you need to do.
You know your healthcare needs, so it’s better if you choose your primary care provider and health plan.
Health plans add new healthcare providers to their networks on a daily basis. Please check the Medicaid and NC Health Choice Provider and Health Plan Lookup Tool again soon.
Call the enrollment site’s customer service center toll-free at 833-870-5500 (TTY: 833-870-5588). You may need your Medicaid ID number when you call. If you speak a language other than English, the call center can still help you using a language assistance service.
Eligibility for Medicaid Managed Care
Medicaid eligibility rules will remain unchanged at this time. If you have questions about eligibility, contact your local department of social services.
Additional FAQs
What is NC Medicaid Direct?
Some people will be in NC Medicaid Direct because it provides services that meet specific needs. For example, it provides the same services currently covered for developmental disability, behavioral health, traumatic brain injury and substance use disorder. To learn more about NC Medicaid Direct, call 1-888-245-0179. To ask to stay in NC Medicaid Direct, including your Local Management Entity-Managed Care Organization (LME-MCO), you must use our form.
Will I lose any services when I enroll?
Most people will not lose any services. All health plans must offer the same basic behavioral health services. But, some services are only offered through Medicaid Direct and the Eastern Band of Cherokee Indians (EBCI) Tribal Option.
Why can I only visit certain doctors?
Your health plan works with a provider network. A network is a group of doctors, hospitals and other health care providers who have an agreement with a health plan to give members medical care.
Each health plan has a network of doctors for regular visits and specialists when you need certain services, like physical therapy.
What if I have a scheduled visit with a doctor who is not in my health plan’s network?
Call your health plan. You can also ask the doctor to join your health plan’s network.
What if I have a chronic health condition, standing appointments or an upcoming surgery or procedure?
If you have standing appointments, contact your chosen health plan to ask if they will still be covered. Call your health plan.
How do I choose a health plan?
Use these questions to help you choose the best plan for you:
- Do you want to keep your current doctor or clinic? Or do you want a new one?
- Does the health plan have the doctors, hospitals and specialists you use?
- Does anyone in your family have special health needs?
- What added services does the plan have?
- What are the differences between the health plans?
All health plans are required to have the same Medicaid services, such as office visits, blood tests and X-rays. Health plans may also offer added services.
There are five health plans available. These include:
What is the Eastern Band of Cherokee Indians (EBCI) Tribal option?
The EBCI Tribal Option is a health plan for people who are federally recognized tribal members or qualify for Indian Health Services (IHS) and live in Cherokee, Haywood, Graham, Jackson or Swain County or in a neighboring county of the five-county region. The EBCI Tribal Option offers all Medicaid medical, behavioral, and pharmacy services. It addresses health issues common to Native Americans.
What happens after I enroll?
After you enroll, your health plan will mail you information and a new ID card. You will use this ID card to get health care services.
Can I change my health plan after I enroll?
Yes. In the first 90 days, you can change your health plan for any reason. After that, unless you have a special reason, you cannot change your health plan until your Medicaid recertification date. Reasons for changes are listed on the Health Plan Change Request form (PDF). We will send you a letter telling you when you can choose a new health plan without a special reason.
What if I move or get a new job, or if my life changes in another way?
You may have to change your health plan when you have a life change. For example, you might have moved to a new home. Life changes can make a difference in your health plan choices. Contact your local department of social services and explain your change.
How do I get behavioral health, intellectual and developmental disability (I/DD) or traumatic brain injury (TBI) services?
If you are enrolled in NC Medicaid Direct, call 1-888-245-0179. In NC Medicaid Direct, you may be able to get services from a Local Management Entity-Managed Care Organization (LME-MCO). View a list of NC Medicaid Direct behavioral health, I/DD and TBI services.To ask to stay in NC Medicaid Direct, including your LME-MCO, you must use our form.
If you enroll in a health plan through NC Medicaid Managed Care, you may not be able to get certain NC Medicaid Direct services. If you joined a health plan through NC Medicaid Managed Care and need certain services for developmental disability, behavioral health, TBI or substance use disorder, you may have more choices.
Is there an NC Medicaid Managed Care mobile app?
Yes. You can use the app to:
- Find and view primary care providers (PCPs) and health plans
- Choose a PCP
- Enroll (join a health plan)
You cannot use the app to apply for NC Medicaid.
Please have your NCID ready. You must sign in with your NCID to enroll using the app.
What is an NCID?
An NCID is a web-based application with a secure login. It gives you access to resources and your information. When you enroll online in NC Medicaid Managed Care, you will need to use your NCID signin. You can change your NCID username and password if you don’t remember them. If you don't have an NCID account, you will need to create one to enroll in NC Medicaid Managed Care online.
How do I go paperless?
Paperless means you stop getting paper letters by mail and get them online instead. You can get an email, text message or both when you have a letter to view online. All of your letters will be online in your NC Medicaid Managed Care account.
Going paperless is faster than getting letters by mail. You can view the letters in your NC Medicaid Managed Care account as soon as they are ready, so you do not have to wait for the mail.
Going paperless is also easier. The letters in your NC Medicaid Managed Care account will never be removed, so you do not have to keep copies of letters mailed to you. You can go back to read them in your NC Medicaid Managed Care account at any time.
You may stop going paperless at any time. If you do, you will get letters by mail again.
How do I apply for NC Medicaid?
There are 3 ways to apply:
- Apply for NC Medicaid online.
- Mail a paper application or drop it off at your local Department of Social Services (DSS).
- Apply in person at your local DSS.
Contact your local department of social services if you cannot apply one of these ways.