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NC Medicaid Managed Care FAQs

As of July 1, 2021, most Medicaid patients are now enrolled in Medicaid Managed Care. Medicaid Managed Care is a new way of getting Medicaid services. Under Medicaid Managed Care, you choose or are assigned to a Medicaid health plan. If you did not pick a Medicaid health plan by May 21, 2021, you were auto-enrolled into a health plan. If you are in Managed Care, your new health plan should have mailed you a new Medicaid ID card and other information. You can change your Medicaid health plan before September 30, 2021.

Here are answers to some frequently asked questions about NC Medicaid Managed Care.

1. What is Medicaid Managed Care?

NC Medicaid Managed Care is a new way of getting Medicaid. Under Medicaid Managed Care, you choose or are assigned to a Medicaid health plan. You will receive care through the health plan’s network of doctors and health professionals. All plans cover the same basic Medicaid services, such as office visits, blood tests, and non-emergency medical transportation. Health plans can offer extra services like programs to help you quit smoking, eat healthier, and have a healthy pregnancy. You have until September 30, 2021 to change your health plan for any reason.

2. Who is enrolled in NC Medicaid Managed Care health plans?

Most NC Medicaid recipients are now enrolled in NC Medicaid Managed Care. If you did not pick a Medicaid health plan by May 21, 2021, you were auto-enrolled in a health plan. If you are in Managed Care, your new health plan should have mailed you a new Medicaid ID card and other information. If you still need this information, call the Enrollment Broker at 833-870-5500.

Some Medicaid recipients will not be in Managed Care because of the health services they need. Your Medicaid will not change if you receive Innovations Waiver services, Traumatic Brain Injury (TBI) Waiver services, or Community Alternatives Programs for Children or Disabled Adults (CAP/C or CAP/DA) services. If you qualify, you can choose the Eastern Band of Cherokee Indians (EBCI) Tribal Option to continue receiving waiver services. If you do not know what type of Medicaid you have, call 833-870-5500.

3. Have NC Medicaid eligibility rules changed?

No. There are no changes to who is eligible for Medicaid. The same services are still covered. However, your health plan’s network will determine which providers you can see.

4. What are the differences between the Medicaid Managed Care health plans?

All Medicaid health plans offer the same basic benefits and services. Your Medicaid copays will not change. The plans differ in two main ways. First, each plan offers extra services to help you stay healthy. Second, each plan has a specific network of doctors, hospitals, and other health care providers. You must see providers in your plan’s network.

Visit ncmedicaidplans.gov or call 833-870-5500 to learn more about Medicaid health plans and the services they provide.

5. How do I know which providers are in my health plan’s network?

Visit your Medicaid health plan website or call your health plan to learn which providers are in your health plan’s network. If you do not know which plan you have, call the Enrollment Broker at 833-870-5500.

UNC Health providers are included in all Medicaid plans’ provider networks.

6. How do I change my health plan?

You can change Medicaid health plans for any reason until September 30, 2021. Here are the ways to change your health plan:

  • Call 833-870-5500 (toll-free)
  • Go to ncmedicaidplans.gov
  • Complete and return a paper enrollment form by fax or mail
  • Use the NC Medicaid Managed Care mobile app

After September 30, 2021, you must wait until your next recertification date to change health plans unless you have a special reason. These special reasons include:

  • You moved out of your health plan’s area.
  • You need a service that your health plan does not cover for moral or religious reasons.
  • Your health plan says you need multiple services they cannot provide, and your doctor says you need services right away.
  • You need services for specific needs, like intellectual or developmental disability, behavioral health, traumatic brain injury, or substance use disorder.
  • You are a federally recognized tribal member or qualify for Indian Health Services (IHS).

You will have 90 days to change your plan after each recertification date.

7. I have a problem that the Enrollment Broker and my Medicaid health plan cannot fix. How can I get help?

The NC Medicaid Ombudsman is a free program for Medicaid Managed Care recipients. The Ombudsman program can help you with these issues and more:

  • You have trouble enrolling in a health plan, and your assigned health plan and the Enrollment Broker cannot help.
  • Your health plan will not cover care that you need.
  • You have problems changing to a different health plan or doctor.
  • You cannot access materials in your preferred language.
  • You need more information about the Medicaid application process.

Learn More

For help, call the Ombudsman at 877-201-3750. The NC Medicaid Ombudsman office hours are 8 a.m. to 5 p.m., Monday through Friday. The office is closed on state holidays. If no one answers, leave a message with your name and phone number. They will call you back by the next business day. You can also send a message using their online Contact Form: https://bit.ly/2Un1Q4r

Call 877-201-3750