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 health plan has its own network of qualified doctors and health care professionals. 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.

NC Medicaid Managed Care Launch

NC Medicaid within the Department of NC Health and Human Services manages the North Carolina Medicaid and NC Health Choice health care programs, pharmacy benefits and behavioral health services.

A Medicaid beneficiary is an individual who is entitled to receive benefits from NC Medicaid. You become a beneficiary after you apply, are approved, and enroll in a benefits program.

On July 1, 2021, most Medicaid beneficiaries will begin receiving the same Medicaid services in a new way. Called “Medicaid Managed Care“, beneficiaries will choose a health plan and receive care through the health plan’s network of doctors.

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. Most people in NC Medicaid must choose a health plan in the NC Medicaid Managed Care program. Some people can choose to stay in NC Medicaid Direct. They will not need to choose a health plan. 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 to chat with us online. To learn more about NC Medicaid Managed Care, go to Get answers.

Even if you already chose a health plan, you would need to choose again. If you do not choose a health plan, we will choose one for you. You know your needs best, so it is better if you choose.

Who has the option to choose a health plan?

You have the option to choose a health plan if you:

  • Are a federally recognized tribal member or qualify for Indian Health Services (IHS) and live in Cherokee, Haywood, Graham, Jackson or Swain County or in a neighboring county of the 5-county region. You may choose to enroll in 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.
  • Need certain services to address needs related to developmental disability, behavioral health, traumatic brain injury or substance use disorder.

For questions, call 1-888-245-0179. To learn more about NC Medicaid Direct, go to  Get answers.

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, call us at 1-833-870-5500 (TTY: 1-833-870-5588). The call is toll free. Or use the chat tool to chat with us online.

All health plans offer the same basic benefits and services.

Some services may only be available with prior authorization (pre-approval) or if medically necessary.

Medical benefits and services include:

  • Ambulance services
  • Cardiac procedures
  • Certified pediatric and family nurse practitioner services
  • Chiropractic services
  • Clinic services
  • Dietary evaluation and counseling and medical lactation services
  • Durable medical equipment
  • Early and periodic screening, diagnostic and treatment services (EPSDT)
  • Family planning services
  • Federally qualified health center services
  • Freestanding birth center services (when licensed or otherwise recognized by the North Carolina Department of Health and Human Services)
  • Hearing aids
  • Home health services
  • Home infusion therapy
  • Hospice services
  • Inpatient hospital services
  • Inpatient psychiatric services for individuals under age 21
  • Laboratory and X-ray services
  • Limited inpatient and outpatient behavioral health services
  • Maternal support services
  • Transportation to medical care
  • Nursing facility services
  • Obstetrics and gynecological services
  • Occupational therapy
  • Ophthalmological services
  • Optometry services
  • Outpatient hospital services
  • Personal care services
  • Pharmacy services
  • Physical therapy
  • Physician services
  • Podiatry services
  • Prescription drugs and medication management
  • Private duty nursing services
  • Prosthetics, orthotics and supplies
  • Respiratory care services
  • Rural health clinic services
  • Speech, hearing and language disorder services
  • Telemedicine
  • Tobacco cessation counseling for pregnant women
  • Transplants and related services
  • Vision services

Behavioral health benefits and services include:

  • Ambulatory detoxification services
  • Diagnostic assessment services
  • Early and periodic screening, diagnostic and treatment services (EPSDT) for members under age 20
  • Facility-based crisis services for children and adolescents
  • Inpatient behavioral health services
  • Medically supervised alcohol and drug abuse treatment center detoxification, crisis stabilization
  • Mobile crisis management services
  • Non-hospital medical detoxification services
  • Outpatient behavioral health emergency room services
  • Outpatient behavioral health services provided by direct-enrolled providers
  • Outpatient opioid treatment services
  • Partial hospitalization
  • Professional treatment services in a facility-based crisis program
  • Research-based intensive behavioral health treatment

There are some services each health plan does not provide.

You can get these services from a provider outside of the health plan’s network, as long as the provider takes Medicaid:

  • Dental services
  • Services provided by local education agencies
  • Services provided by children’s developmental agencies that are included in your child’s Individualized Family Service Plan
  • Fabrication of eyeglasses, including complete eyeglasses, eyeglass lenses and ophthalmic frames

What do I need to do when open enrollment starts on March 15, 2021?

UPDATE 5/19/21: Open Enrollment was extended to March 15, 2021- May 21,2021

When open enrollment starts, you will need to choose a primary care provider (PCP) and health plan.

Once you find a PCP and health plan, you must enroll. You can 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.

To learn more about what you need to do, watch NC Medicaid Managed Care: What You Need to Do.

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: 1-833-870-5588). 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 care to get health care services.

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

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 for changes 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 toll free. Or use the chat tool to chat with us online.

Where can I call to get help?

Assistance with enrollment is available from 7 a.m. to 5 p.m., Monday through Saturday at 1-833-870-5500 (TTY: 1-833-870-5588). During open enrollment, from March 15, 2021 through May 21, 2021, extended hours are offered from 7 a.m. to 8 p.m., 7 days a week. 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: 1-833-870-5558). 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.

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 6 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.

The Eastern Band of Cherokee Indians (EBCI) Tribal Option
EBCITribalOption.com

The EBCI Tribal Option is for people who are federally-recognized tribal members or qualify for Indian Health Services (IHS) and live in Cherokee, Haywood, Graham, Jackson or Swain County or in a neighboring county of the 5-county region. As a member of the EBCI Tribal Option, you can still get services from any Medicaid or NC Health Choice provider.

To learn more about your health plan choices and choose a plan:

What happens if I do not select a health plan or primary care provider (PCP)?

If you do not choose a health plan, one will chosen 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.  You can change your health plan for any reason through September 30, 2021.

How do I get behavioral health, intellectual and developmental disability (I/DD) or traumatic brain injury services (TBI)?

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.

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: 1-833-870-5588). 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.

Additional Information and Helpful Links: