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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.

To learn more about what to do if you have questions, watch NC Medicaid Managed Care: Get Answers.

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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, hospital services, blood tests, care coordination 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. Health plans work with different doctors and health care professionals. Each health plan has its own network of qualified doctors and health care professionals. All health plans must have enough providers for the covered services you need. To keep your doctor, clinic or other provider, find out which health plans they work with. Then choose one of those health plans.

To learn more about NC Medicaid Managed Care, watch NC Medicaid Managed Care: Introduction.

What is a health plan?

A health plan is a group of doctors, hospitals and other health care providers. They work together to give you the health care you need. This includes physical health, behavioral health and medicine. The 5 health plans available are WellCare, UnitedHealthcare Community Plan, Healthy Blue, AmeriHealth Caritas and Carolina Complete Health.

What are the differences between the health plans?

All health plans are required to have the same Medicaid services, such as office visits, hospital services, blood tests, care coordination 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 5 health plans available. These include:

WellCare
wellcare.com/NC

This health plan is offered statewide.

UnitedHealthcare Community Plan
uhccommunityplan.com/nc

This health plan is offered statewide.

HealthyBlue
HealthyBlueNC.com

This health plan is offered statewide.

AmeriHealth Caritas
amerihealthcaritasnc.com

This health plan 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 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 Cherokee, Haywood, Graham, Jackson or Swain County or in a neighboring county of the 5-county region.

The EBCI Tribal Option includes care coordination by Vaya Health for conditions such as developmental disability, behavioral health, traumatic brain injury and substance use disorder. The EBCI Tribal Option also provides added services. As a member of the EBCI Tribal Option, you can still get services from any 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 current health care program for Medicaid beneficiaries who are not enrolled in NC Medicaid Managed Care. NC Medicaid Direct includes care coordination from:

  • Community Care of North Carolina (CCNC), the primary care case management entity (PCCMe)
  • 7 regional Local Management Entity-Managed Care Organizations (LME-MCOs)
    • LME-MCOs coordinate services for conditions such as developmental disability, behavioral health, traumatic brain injury and substance use disorder

Some people will be 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. To ask to move to NC Medicaid Direct, including your LME-MCO, use the Request to Move to NC Medicaid Direct (Fee for Service) or LME-MCO: Beneficiary Form.

If you are a provideryou may ask for a person to move to NC Medicaid Direct. Use the Request to Move to NC Medicaid Direct (Fee for Service) and LME-MCO: Provider Form.

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.

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. CCNC provides care management services. It also works with all Local Management Entity-Managed Care Organizations (LME-MCOs) for beneficiaries with conditions such as developmental disability, behavioral health, traumatic brain injury and substance use disorder.

To learn more, go to communitycarenc.org.

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

An LME-MCO coordinates services for conditions such as developmental disability, behavioral health, traumatic brain injury and substance use disorder. There are 7 LME-MCOs in North Carolina: Alliance Health, Eastpointe, Cardinal Innovations Healthcare, Partners Health, Sandhills Center, Trillium Health and Vaya Health.

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 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 statewide ombudsman network helps Medicaid beneficiaries when they cannot solve problems with their provider or health care option. The NC Medicaid Ombudsman offers 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 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 Medicaid and NC Health Choice beneficiaries.

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 choose a health plan, go to Who must choose a health plan? 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.

Will I lose any services when I enroll in a health plan?

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. As a member of the EBCI Tribal Option, you can still get services from any Medicaid or NC Health Choice provider.

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 NC Medicaid Managed Care 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 NC Medicaid Managed Care 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 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, you can change your health plan:

  • At your Medicaid recertification date
  • If you are required to change health plans
  • If you have a special or “with cause” reason, such as:
    • You moved out of your health plan’s service area
    • You have a family member in a different health plan
    • You cannot get all the related services you need from providers in your health plan, and there is a risk to getting the services separately
    • A different health plan may be better for your complex medical conditions
    • Your Long-Term Services and Supports (LTSS) provider is not in your health plan
    • Your health 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)

We will send you a letter telling you when you can choose a new health 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.

When can I call to get help?

We are open from 7 a.m. to 5 p.m., Monday through 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 you choose. Here are four ways to find out which health plans your PCP works with:

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

You can choose your PCP when you enroll in a health plan. To choose the PCP you want after enrolling, 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 care option works with a provider network. A network is a group of doctors, hospitals and other health care providers who contract with a health care option to give members medical care. Each health care option 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 chosen 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 chosen health plan or services covered, contact your health plan. You can view contact information at Contacts and links.

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 the NC Medicaid Contact Center at 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 move to NC Medicaid Direct, including your LME-MCO, use the Request to Move to NC Medicaid Direct (Fee for Service) or LME-MCO: Beneficiary Form.

If you are a provideryou may ask for a person to move to NC Medicaid Direct. Use the Request to move to NC Medicaid Direct (Fee for Service) and LME-MCO: Provider form.

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.

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.

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.

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 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.

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.

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 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. You can change your health plan for any reason up to 90 days after your health plan start date.