NC Medicaid Direct services

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What is NC Medicaid Direct?

NC Medicaid Direct is North Carolina’s health care program for Medicaid beneficiaries who are not enrolled in health plans. It includes care management by Community Care of North Carolina (CCNC), the primary care case management entity (PCCMe). Six Local Management Entity-Managed Care Organizations (LME-MCOs) coordinate services for a mental health disorder, substance use disorder, intellectual/developmental disability (I/DD) or traumatic brain injury (TBI).

Who qualifies for NC Medicaid Direct?

  • Children/youth in foster care
  • Children/youth who get adoption assistance
  • Children who get Community Alternatives Program for Children (CAP/C) services
  • Federally recognized tribal members or others who qualify for services through Indian Health Service (IHS)
  • Former foster care youth
  • People in the Health Insurance Premium Payment (HIPP) program
  • People in the Program for All-Inclusive Care for the Elderly (PACE)
  • People who are medically needy
  • People who get Community Alternatives Program for Disabled Adults (CAP/DA) services
  • People who get Family Planning Medicaid only
  • People who get Medicaid and Medicare
  • People who may have a mental health disorder, substance use disorder, intellectual/developmental disability (I/DD) or traumatic brain injury (TBI)

NC Medicaid Direct services

NC Medicaid Direct offers certain services that Standard Plans don’t have, such as:

  • Assertive community treatment (ACT)
  • Child and adolescent day treatment services
  • Community support team (CST)
  • Intensive in-home services
  • Multi-systemic therapy services
  • Psychiatric residential treatment facilities (PRTFs)
  • Psychosocial rehabilitation
  • Residential treatment facility services
  • Substance abuse comprehensive outpatient treatment program (SACOT)
  • Substance abuse intensive outpatient program (SAIOP)
  • Substance abuse medically monitored residential treatment
  • Substance abuse non-medical community residential treatment

For a full list of services that all health plans offer, go to Benefits and services.

How to move to NC Medicaid Direct

Request to move to NC Medicaid Direct and LME-MCO: If you have mental health disorder, substance use disorder, intellectual/developmental disability (I/DD) or traumatic brain injury (TBI) support needs, you may ask to move to NC Medicaid Direct, including your Local Management Entity-Managed Care Organization (LME-MCO). Use the Request to Move to NC Medicaid Direct (Fee for Service) or LME-MCO Form.