NC Medicaid Managed Care

There is a new way to get Medicaid healthcare through health plans. Most people will get the same Medicaid services in this new way. If you have questions about if this applies to your situation, reach out by phone (1-833-870-5500) or online chat (ncmedicaidplans.gov). Open enrollment for NC Medicaid Managed Care ends on May 14th, so it’s important to act quickly to choose a health plan that works for you! 

What is a health plan? 

A health plan is a group of doctors, hospitals and other providers. They work together to give you the healthcare you need, including physical health, behavioral health, and medicine. You will also be able to choose a primary care provider. All health plans offer the same basic benefits and services. CLICK HERE to learn more. 

Who needs to choose a health plan? 

Most North Carolinians must choose a health plan in the NC Medicaid Managed Care Program, though some can choose to stay in NC Medicaid Direct. NC Medicaid Managed Care will send you a letter that tells you if you must enroll. To find out now, call 1-833-870-5500 (TTY: 1-833-870-5588). The call is toll free. Or use the chat tool on ncmedicaidplans.gov. This help center is neutral and can help answer questions to make sure that recipients understand the options available and make an information decision. 

Who cannot choose a health plan? 

Some people will not need to choose a health plan because of the type of health services they need. They will stay enrolled in NC Medicaid Direct. For example, individuals who get Innovations Waiver services, Traumatic Brain Injury (TBI) Waiver services, or Community Alternatives Program for Children (CAP/C) or Community Alternative Program for Disabled Adults (CAP/DA) services will stay enrolled in NC Medicaid Direct. If you qualify, you can choose the EBCI Tribal Option and keep getting waiver services. To learn more, go to NC Medicaid Direct services.

If you have behavioral health, substance use, intellectual and developmental disability (I/DD) or traumatic brain injury (TBI) support needs, you may ask to stay in NC Medicaid Direct to keep getting services through 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.

How do I choose a health plan? 

All health plans offer the same basic benefits and services, but some may offer added services. CLICK HERE to view your choices for health plans. 

How can I enroll for a health plan? 

Open enrollment ends on May 14, 2021. There are several ways you can complete the enrollment process: 

  • Online at ncmedicaidplans.gov/enroll 
  • Through the mobile phone app. Search for NC Medicaid Managed Care on Google Play (Android) or the App Store (iPhone).
  • By phone. Call 1-833-870-5500 7am-8pm, Monday-Sunday. 
  • By mail or fax. CLICK HERE to find the paper application. 
    • Mail: NC Medicaid, PO Box 613, Morrisville NC  27560
    • Fax: 1-833-898-9655.

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.

Your new health plan will be available starting July 1, 2021. Until your start date, you will continue to access care and services the way you do now.

Need more information? 

CLICK HERE to read answers to frequently asked questions or call 2-1-1 to speak with a NC 211 call specialist. 

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