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Most people in NC Medicaid must enroll in a Standard Plan in the NC Medicaid Managed Care program. But health care options depend on the person’s specific situation.
Who qualifies for a Standard Plan?
- Most families and children
- Children who get NC Health Choice
- Pregnant women
- People who are blind or disabled and do not get Medicare
- Federally recognized tribal members or others who qualify for services through Indian Health Service (IHS)
Who qualifies for the EBCI Tribal Option?
- Federally recognized tribal members or others who qualify for services through Indian Health Service (IHS) who live in the following counties: Buncombe, Clay, Cherokee, Graham, Haywood, Henderson, Jackson, Macon, Madison, Swain, Transylvania
Who qualifies for a Tailored Plan?
- People who get Innovations Waiver services
- People who get Traumatic Brain Injury (TBI) Waiver services
- People who may have a mental health disorder, substance use disorder, intellectual/developmental disability (I/DD) or traumatic brain injury (TBI)
Tailored Plans will start October 1, 2023. Some people will be automatically enrolled in a Tailored Plan based on their needs. the option to choose the Tailored Plan, you will get a notice in the mail to tell you. To learn more, go to Tailored Plan services.
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)
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.