We’re here to help you understand your primary care provider (PCP) and health plan choices. Here are answers to questions you may have.
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What is NC Medicaid Managed Care?
NC Medicaid Managed Care helps you get the most out of your Medicaid benefits. Instead of one Medicaid program there are many health plans to choose from.
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 such as programs to help you quit smoking, eat healthier and have a healthy pregnancy. Health plans work with different doctors and health care professionals. Each health plan has its own network of qualified doctors and health care professionals. To keep your doctor, clinic or other provider, find out which health plans they work with. Then choose one of those health plans.
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. We will share the request form starting March 1, 2021.
Is NC Medicaid eligibility changing?
No. NC Medicaid eligibility rules are not changing. If you have questions about your eligibility, contact your local Department of Social Services (DSS) office. Find contact information at ncdhhs.gov/localdss.
What is 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. They will also coordinate your care with other health providers.
What is a health plan?
A health plan is a group of doctors, hospitals and other health care professionals. They work together to give you the health care you need.
What is a provider-led entity?
A provider-led entity is a Medicaid health plan that is mainly led by doctors or other health care providers. They have experience serving NC Medicaid and NC Health Choice members.
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 5-county region. The EBCI Tribal Option offers all Medicaid medical, behavioral and pharmacy services. It addresses health issues common to Native Americans.
Do I have to choose a health plan?
It depends. Most people in NC Medicaid must choose a health plan. Some people can choose to stay in NC Medicaid Direct. They will not need to choose a health plan. To find out if you must enroll, go to Who must choose a health plan?
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 NC Medicaid Direct and the Eastern Band of Cherokee Indians (EBCI) Tribal Option.
What do I need to do when open enrollment starts on March 15, 2021?
When open enrollment starts, you will need to choose a primary care provider (PCP) and health plan. You can find and view PCPs and health plans to choose the best one for you.
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 sign-in. 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.
What is the deadline to enroll?
Members should enroll by May 14, 2021.
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.
Your new health plan will be available starting July 1, 2021. Until your start date, you can get care and services the way you do now.
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.
We will send you a letter telling you when you can choose a new health plan without a special reason.
When can I call to get help?
Our call center opens March 1, 2021. You may need your Medicaid ID number when you call. The call is free. If you do not speak English, our call center is still available to help you with a language assistance service.
Can I keep my current primary care provider (PCP)?
Yes, if your PCP is in the health plan you choose. You can choose your PCP when you enroll in a health plan. To choose the PCP you want after enrolling, call your health plan.
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.
How do I choose a health plan?
Use these questions to help you choose the best health plan for you:
- Do you want to keep your current provider? Or do you want a new one?
- Does the health plan have the providers, hospitals and specialists you use?
- Does anyone in your family have special health needs?
- What added services does the health plan have?
If you want to keep your primary care provider (PCP), choose a health plan your PCP works with. When you’ve chosen your PCP and health plan, you can enroll. Open enrollment starts March 15, 2021.
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 such as programs to help you quit smoking, eat healthier and have a healthy pregnancy.
There are 6 health plans available. These include:
This health plan is offered statewide.
UnitedHealthcare Community Plan
This health plan is offered statewide.
This health plan is offered statewide.
This health plan is offered statewide.
Carolina Complete Health
Carolina Complete Health is a provider-led entity offered to people who live in these counties: Alamance, Alexander, Anson, Bladen, Brunswick, Cabarrus, Caswell, Catawba, Chatham, Cleveland, Columbus, Cumberland, Durham, Franklin, Gaston, Granville, Harnett, Hoke, Iredell, Johnston, Lee, Lincoln, Mecklenburg, Montgomery, Moore, Nash, New Hanover, Orange, Pender, Person, Richmond, Robeson, Rowan, Sampson, Scotland, Stanly, Union, Vance, Wake, Warren, Wilson.
The Eastern Band of Cherokee Indians (EBCI) Tribal Option
The EBCI Tribal Option is 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 5-county region.
Who do I contact if I have specific questions about my health plan or the services covered?
For questions about your chosen health plan or services covered, contact your health plan.
What happens if I don’t select a health plan or primary care provider (PCP)?
If you do not choose a health plan, we will choose one for you. If you do not choose a PCP, your health plan will choose one for you. It's better if you choose because you know your health care needs best.
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. Call your local Department of Social Services (DSS) and explain your change. You can find your local office at ncdhhs.gov/localdss.
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). For a list of NC Medicaid Direct behavioral health, I/DD and TBI services, go to NC Medicaid Direct services. To ask to stay in NC Medicaid Direct, including your LME-MCO, you must use our form. We will share the request form starting March 1, 2021.
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 get the free mobile app starting March 1, 2021.
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.
We will share links to the app on this website when it is ready.
Please have your NCID ready. You must sign in with your NCID to enroll using the app.
If you don’t know your NCID username or password, go to the NCID sign-in page. Select “Forgot Username” or “Forgot Password.” To reset your password or unlock your account, you may have to answer questions or verify through your mobile device.
How do I go paperless?
Starting March 15, 2021, you can 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:
- Online: Apply online at ePass.
- Mail: Mail a paper application or drop it off at your local Department of Social Services (DSS). Get a copy of the paper application.
- In person: Apply in person at your local DSS.
Call your local DSS if you cannot apply one of these ways. For a list of local DSS locations, go to ncdhhs.gov/localdss.
To learn more about how to apply for NC Medicaid, go to https://medicaid.ncdhhs.gov/medicaid/get-started/apply-for-medicaid-or-health-choice.