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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: 1-833-870-5588). The call is free. Or use the chat tool to chat with us online.

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 plan has its own network of qualified doctors and health care professionals. To keep your doctor, clinic or other provider, find out which plans they work with. Then choose one of those 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, mental illness, traumatic brain injury and substance use disorder. To learn more about NC Medicaid Direct, call 1-888-245-0179To ask to stay in NC Medicaid Direct, including your Local Management Entity-Managed Care Organization (LME-MCO), use the Request to stay in NC Medicaid Direct and LME-MCO: Beneficiary form.

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

Is Medicaid eligibility changing?

No. 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 https://www.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.

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 plan.

To find out if you must enroll, go to Who must choose a health plan? If you still have questions, call us at 1-833-870-5500 (TTY: 1-833-870-5588). The call is free. Or use the chat tool to chat with us online.

Will I lose any services when I enroll?

No. You will not lose any services. Health plans may also offer added services.

What do I need to do?

  1. Choose a primary care provider (PCP)
  2. Choose a health plan – compare the plans and choose the best one for you 
  3. Enroll online, use the NC Medicaid Managed Care mobile app, call us toll free at 1-833-870-5500 (TTY: 1-833-870-5588) or fill out and mail back the enrollment form sent to you.

What is the deadline to enroll?

Members should enroll by December 13, 2019.

What happens after I enroll?

After you enroll, your health plan will mail you information and new Medicaid card. You will use this Medicaid card to get health care services.

Your new health plan will be available starting February 1, 2020.

Until your start date, 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 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. To learn more, call us at 1-833-870-5500 (TTY: 1-833-870-5588). The call is 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: 1-833-870-5588). During enrollment, from July 15, 2019 through September 13, 2019 and October 14, 2019 through December 13, 2019, we have extended hours from 7 a.m. to 8 p.m., 7 days a week. The call is 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 different ways you can find out which plans your PCP works with:

  • Ask your PCP.
  • Call us at 1-833-870-5500 (TTY: 1-833-870-5558). The call is free.
  • Go to Find a provider.
  • Find a list of doctors and other specialists for each health plan on the free mobile app.

You can choose your PCP when you enroll in a health plan. To choose the PCP you want after enrolling, call your health plan at the number on your Medicaid card. 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, 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. 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/procedure?

If you have standing appointments, contact your chosen health plan to ask if they will still be covered. Call your health plan at the number on your Medicaid card. You can also view contact information for the health plans at Contacts and links.

How do I choose a health plan?

Choose a plan your primary care provider (PCP) is in. 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? 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 plan have?

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

If you want to keep your PCP, choose a health plan your PCP works with. When you’ve chosen your PCP and health plan, go to Enroll, use the free NC Medicaid Managed Care mobile app or call 1-833-870-5500 (TTY: 1-833-870-5588) to make your selection. The call is free.

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 five health plans available. These include:

WellCare
1-866-799-5318 (TTY: 711) | www.wellcare.com/NC

UnitedHealthcare Community Plan
1-800-349-1855 (TTY: 711) | www.uhccommunityplan.com/nc

HealthyBlue
1-844-594-5070 (TTY: 711) | www.HealthyblueNC.com

AmeriHealth Caritas
1-855-375-8811 (TTY: 1-866-209-6421) | www.amerihealthcaritasnc.com

Carolina Complete Health
1-833-552-3876 (TTY: 711) | www.carolinacompletehealth.com

Carolina Complete Health is offered to people who live in these counties: Alexander, Anson, Bladen, Brunswick, Cabarrus, Catawba, Cleveland, Columbus, Cumberland, Gaston, Harnett, Hoke, Iredell, Lee, Lincoln, Mecklenburg, Montgomery, Moore, New Hanover, Pender, Richmond, Robeson, Rowan, Sampson, Scotland, Stanly, Union.

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

If you have questions about choosing a health plan, go to Tips for choosing a health plan, use the chat feature on this website or call 1-833-870-5500 (TTY: 1-833-870-5588) to learn more and choose a plan. The call is free.

For questions about your chosen health plan or services covered, contact your health plan. Call your health plan at the number on your Medicaid card. You can also 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 one will be chosen 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.

Is my health plan changing?

To find out if your health plan is changing, call us at 1-833-870-5500 (TTY: 1-833-870-5588). The call is free. Or use the chat tool to chat with us online.

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 https://www.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, use the Request to stay in NC Medicaid Direct and LME-MCO: Beneficiary form.

If you are a provider, you may ask for a person to stay in NC Medicaid Direct. Use the Request to stay in NC Medicaid Direct (Fee for Service) and LME-MCO: Provider 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, mental illness, TBI or substance use disorder, you may have more choices.

To learn more about your choices, call us at 1-833-870-5500 (TTY: 1-833-870-5588). The call is 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 free app to:

  • Find primary care providers (PCPs)
  • Choose a PCP
  • Compare NC Medicaid Managed Care health plans
  • Enroll (join a health plan)

You cannot use the app to apply for NC Medicaid.

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

How do I go paperless?

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.

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: 1-833-870-5588). The call is 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.
 

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 https://www.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.