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We’re here to help you understand your primary care provider (PCP) and health plan choices. Here are answers to questions you may have.

If you have other questions, call us at 1-833-870-5500 (TTY: 711 or RelayNC.com). The call is toll free. Or use the chat tool to chat with us online.

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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 health plans to choose from based on your health care needs.

All health plans are required to have the same Medicaid services, such as office visits, hospital services, blood tests, care management and X-rays. Some health plans also offer added services, such as programs to help you quit smoking, eat healthier and have a healthy pregnancy.

Each health plan has its own network of qualified doctors and health care professionals (provider network). All health plans must have enough providers for the covered services you need.

What is a Standard Plan?

A Standard Plan is a North Carolina Medicaid and NC Health Choice health plan. It offers physical health, pharmacy, care management and basic behavioral health services for members. Standard Plans offer added services for members who qualify.

There are five Standard Plans. These include:

WellCare

wellcarenc.com

WellCare is offered statewide.

UnitedHealthcare Community Plan

uhccommunityplan.com/nc

UnitedHealthcare Community Plan is offered statewide.

Healthy Blue

HealthyBlueNC.com

Healthy Blue is offered statewide.

AmeriHealth Caritas

amerihealthcaritasnc.com

AmeriHealth Caritas is offered statewide.

Carolina Complete Health

carolinacompletehealth.com

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.

What is a Tailored Plan?

A Tailored Plan is a North Carolina Medicaid and NC Health Choice health plan. It offers physical health, pharmacy, care management and behavioral health services. It is for members who may have significant mental health needs, severe substance use disorders, intellectual/developmental disabilities (I/DDs) or traumatic brain injuries (TBIs). Tailored Plans offer added services for members who qualify.

Tailored Plan auto-enrollment began August 15, 2022. If you are auto-enrolled in a Tailored Plan or have the option to choose a Tailored Plan, you will receive a notice in the mail. Tailored Plans will start December 1, 2022.

There are six Tailored Plans. These include:

Alliance Health
alliancehealthplan.org

Alliance Health is available in these counties: Cumberland, Durham, Johnston, Mecklenburg, Orange, Wake.

Eastpointe
eastpointe.net

Eastpointe is available in these counties: Duplin, Edgecombe, Greene, Lenoir, Robeson, Sampson, Scotland, Warren, Wayne, Wilson.

Partners Health Management
partnersbhm.org

Partners Health Management is available in these counties: Burke, Cabarrus, Catawba, Cleveland, Davie, Forsyth, Gaston, Iredell, Lincoln, Rutherford, Stanly, Surry, Union, Yadkin.

Sandhills Center
sandhillscenter.org

Sandhills Center is available in these counties: Anson, Davidson, Guilford, Harnett, Hoke, Lee, Montgomery, Moore, Randolph, Richmond, Rockingham.

Trillium Health Resources
trilliumheathresources.org

Trillium Health Resources is available in these counties: Beaufort, Bertie, Bladen, Brunswick, Camden, Carteret, Chowan, Columbus, Craven, Currituck, Dare, Gates, Halifax, Hertford, Hyde, Jones, Martin, Nash, New Hanover, Northampton, Onslow, Pamlico, Pasquotank, Pender, Perquimans, Pitt, Tyrrell, Washington.

Vaya Health
vayahealth.com

Vaya Health is available in these counties: Alamance, Alexander, Alleghany, Ashe, Avery, Buncombe, Caldwell, Caswell, Chatham, Cherokee, Clay, Franklin, Graham, Granville, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Person, Polk, Rowan, Stokes, Swain, Transylvania, Vance, Watauga, Wilkes, Yancey.

Why do I only have one Tailored Plan available to me?

Only one Tailored Plan serves each county in North Carolina. Your Tailored Plan is based on the county that manages your Medicaid case.

What is the Eastern Band of Cherokee Indians (EBCI) Tribal Option?

The EBCI Tribal Option is the primary care case management entity (PCCMe) created by the Cherokee Indian Hospital Authority (CIHA). It manages the primary care needs of federally recognized tribal members and others who qualify for services through Indian Health Service (IHS) and live in Buncombe, Clay, Cherokee, Graham, Haywood, Henderson, Jackson, Macon, Madison, Swain or Transylvania counties.

The EBCI Tribal Option includes care coordination by Vaya Health for a mental health disorder, substance use disorder, intellectual/developmental disability (I/DD) or traumatic brain injury (TBI). The EBCI Tribal Option offers added services for members who qualify. As a member of the EBCI Tribal Option, you can get services from any NC Medicaid or NC Health Choice provider.

To learn more, go to ebcitribaloption.com

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) for physical health services.

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).

Some people are enrolled in NC Medicaid Direct because it provides services that meet specific needs. To learn more about NC Medicaid Direct, call the NC Medicaid Contact Center at 1-888-245-0179.

What is a primary care case management entity (PCCMe)?

A PCCMe is a health care program that provides care management services for beneficiaries who qualify.

What is Community Care of North Carolina (CCNC)?

CCNC is the primary care case management entity (PCCMe) for NC Medicaid Direct beneficiaries. CCNC provides care management services. It also works with all Local Management Entity-Managed Care Organizations (LME-MCOs) for beneficiaries with a mental health disorder, substance use disorder, intellectual/developmental disability (I/DD) or traumatic brain injury (TBI).

To learn more, go to communitycarenc.org.

What is a Local Management Entity-Managed Care Organization (LME-MCO)?

An LME-MCO coordinates services for a mental health disorder, substance use disorder, intellectual/developmental disability (I/DD) or traumatic brain injury (TBI) for NC Medicaid Direct beneficiaries and EBCI Tribal Option members. There are six LME-MCOs in North Carolina: Alliance Health, Eastpointe, Partners Health Management, Sandhills Center, Trillium Health Resources and Vaya Health.

What is a primary care provider (PCP)?

A PCP is a doctor, nurse practitioner or physician assistant. They care for your health, coordinate your needs, and refer you to specialists when you need them.

What is the NC Medicaid Ombudsman?

The NC Medicaid Ombudsman helps NC Medicaid and NC Health Choice beneficiaries understand the changes happening as the state moves to NC Medicaid Managed Care. The NC Medicaid Ombudsman helps Medicaid beneficiaries when they cannot solve problems with their provider or health plan. They offer free, confidential support and education about the rights and responsibilities of Medicaid beneficiaries.

The NC Medicaid Ombudsman can help Medicaid beneficiaries get access to health care and connect beneficiaries to resources like legal aid, social services and other programs. To learn more, call the NC Medicaid Ombudsman toll free at 1-877-201-3750, 8 a.m. to 5 p.m., Monday through Friday, except state holidays. Or visit them online at ncmedicaidombudsman.org.

You should call the NC Medicaid Ombudsman when you:

  • Are not getting the care you need
  • Have questions about a notice or bill
  • Have talked with your provider or health care option and cannot solve a problem
  • Have questions about the complaint or appeal process

Is NC Medicaid eligibility changing?

No. NC Medicaid eligibility rules and processes 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 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 beneficiaries.

Do all health plans offer the same services?

All health plans offer the same basic benefits and services. Some health plans also offer added services.

Tailored Plans offer certain services that Standard Plans don’t have. These include services for a mental health disorder, substance use disorder, intellectual/developmental disability (I/DD) or traumatic brain injury (TBI).

To learn more, go to Benefits and services.

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 in a health plan online, 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 a health plan online.

How do I enroll online?

It is quick and easy to enroll online. You will need to have your NCID ready in order to log in and get started.

Online: Log in to your NC Medicaid Managed Care account.

Once you log in, you can:

  • Find a provider
  • View health plans
  • View and change your information

To learn more about how to enroll online, go to Enroll. If you still have questions, call us at 1-833-870-5500 (TTY: 711 or RelayNC.com). The call is toll free. Or use the chat tool to chat with us online.

What happens after I enroll?

After you enroll, you will receive information and a new Medicaid ID card. You will use this Medicaid ID card to get health care services.

Can I change my Standard Plan after I enroll?

Most people can change their Standard Plan within 90 days of Standard Plan enrollment.

When you enroll in a Standard Plan, you can change your Standard Plan for any reason within 90 days. After that, you can change your Standard Plan:

  • At your Medicaid recertification date
  • If you are required to change Standard Plans
  • If you have a special or “with cause” reason, such as:
    • You moved out of your Standard Plan’s service area
    • You have a family member in a different Standard Plan
    • You cannot get all the related services you need from providers in your Standard Plan, and there is a risk to getting the services separately
    • A different health Standard Plan may be better for your complex medical conditions
    • Your Long-Term Services and Supports (LTSS) provider is not in your Standard Plan
    • Your Standard Plan does not cover a service you need for moral or religious reasons
    • Other reasons (poor quality of care, lack of access to covered services, lack of access to providers experienced in dealing with your health care needs)

If you want to change your Standard Plan outside of the 90 days, you can request to change your Standard Plan in one of the following ways:

  • Log in to your NC Medicaid Managed Care account. You will need to have your NCID ready in order to log in and request to change your Standard Plan.
  • Use this website to submit your form. To learn more, go to Submit forms online.
  • Call us toll free at 1-833-870-5500 (TTY: 711 or RelayNC.com).
  • Mail or fax the Standard Plan Change Request form
  • We recently changed this form. Only use it for Standard Plan change requests.

We will send you a letter telling you when you can choose a new Standard Plan without a special reason. To learn more, call us at 1-833-870-5500 (TTY: 711 or RelayNC.com). The call is toll free. Or use the chat tool to chat with us online.

Some people can change their Standard Plan at any time.

You can change your Standard Plan at any time for these reasons:

  • You need services to address a mental health disorder, substance use disorder, intellectual/developmental disability (I/DD) or traumatic brain injury (TBI)
  • You are a federally recognized tribal member or qualify for services through Indian Health Service (IHS)

When can I call to get help?

We are open from 7 a.m. to 8 p.m., Monday through Friday and 7 a.m. to 5 p.m. on Saturday. Call us at 1-833-870-5500 (TTY: 711 or RelayNC.com). The call is toll free.

You may need your Medicaid ID number when you call. If you do not speak English, our call center is still available to help you with a language assistance service. You can also use the chat feature on this website to get answers to your questions.

Can I keep my current primary care provider (PCP)?

Yes, if your PCP is in the health plan’s provider network. Here are four ways to find out which health plans your PCP works with:

  • Go to Find a provider.
  • Find a list of doctors and other specialists for each health plan on the free mobile app.
  • Call us at 1-833-870-5500 (TTY: 711 or RelayNC.com). The call is toll free.
  • Ask your PCP.

To choose the PCP you want, call your health plan. You can also view contact information for the health plans at Contacts and links.

Why can I only visit certain doctors?

Your health plan works with a provider network. A network is a group of doctors, therapists, specialists, hospitals and other health care facilities. 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. For contact information, go to Contacts and links. 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 health plan to ask if they will still be covered. You can view contact information for the health plans at Contacts and links.

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? To find out, use this website or the free NC Medicaid Managed Care mobile app.
  • Does anyone in your family have special health needs?
  • What added services does the health plan have?

To view your health plan choices, go to View health plans. You can also read Tips for choosing a health plan.

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 online, use the free NC Medicaid Managed Care mobile app or call 1-833-870-5500 (TTY: 711 or RelayNC.com) to make your selection. The call is toll free.

Who do I contact if I have specific questions about my health plan or the services covered?

For questions about your health plan or services covered, contact your health plan. You can view contact information at Contacts and links.

What are State-funded services?

State-funded services are mental health disorder, substance use disorder, intellectual/developmental disability (I/DD) and traumatic brain injury (TBI) services the state or federal government pays for outside of Medicaid.

State-funded services are separate from Medicaid services. They are only available through Tailored Plans. If you think you may qualify for State-funded services, contact the Tailored Plan that serves your county. To learn more, go to the Tailored Plan websites listed below.

Alliance Health
alliancehealthplan.org

Eastpointe
eastpointe.net

Partners Health Management
partnersbhm.org

Sandhills Center
sandhillscenter.org

Trillium Health Resources
trilliumhealthresources.org

Vaya Health
vayahealth.com

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.

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.

To get the app, search for NC Medicaid Managed Care on Google Play or the App Store. Download the app today.

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 get mental health disorder, substance use disorder, intellectual/developmental disability (I/DD) or traumatic brain injury (TBI) services?

Most people who have a mental health disorder, substance use disorder, intellectual/developmental disability (I/DD) or traumatic brain injury (TBI) get their Medicaid services through NC Medicaid Direct. If you are enrolled in NC Medicaid Direct, call the NC Medicaid Contact Center at 1-888-245-0179.

If you are not enrolled in NC Medicaid Direct, you may ask to move to NC Medicaid Direct. To ask to move to NC Medicaid Direct, use the Request to Move to NC Medicaid Direct (Fee for Service) or LME-MCO: Beneficiary Form.

If you are a provider, you may ask for a person to move to NC Medicaid Direct. Use the Request to move to NC Medicaid Direct (Fee for Service) or LME-MCO: Provider form. Providers can use this form to submit service associated or non-service associated requests. For service associated requests, providers need to include a Service Authorization Request (SAR) and supporting documents.

You can use this website to submit your form. It is the fastest and best way to submit a form. To learn more, go to Submit forms online.

To learn more about your choices, call us at 1-833-870-5500 (TTY: 711 or RelayNC.com). The call is toll free. Or use the chat tool to chat with us online.

How do I go paperless?

It's easy to 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.

Once you enroll in a health plan, you may choose to go paperless. There are three ways to sign up:

  • Online: Log in to your NC Medicaid Managed Care account.
  • Mobile app: To get the free mobile app, search for NC Medicaid Managed Care on Google Play or the App Store.
  • Phone: Call us at 1-833-870-5500 (TTY: 711 or RelayNC.com). The call is toll free.

You may sign up for emails, text messages or both. 

Once you go paperless, you will not get any letters by mail about your health plan. 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.

Can I get this website information in print?

Yes, you can get this information in print. To ask for a free copy, call us at 1-833-870-5500 (TTY: 711 or RelayNC.com). The call is toll free. Or use the chat tool to chat with us online. We will provide this information within five business days.

How do I apply for NC Medicaid?

There are three 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 medicaid.ncdhhs.gov/medicaid/get-started/apply-for-medicaid-or-health-choice

Why am I unable to find my provider?

Please check the Medicaid and NC Health Choice Provider and Health Plan Lookup Tool again later. Health plans add new providers to their networks, so we update the tool each day.