Managed Medicaid

Managed Medicaid Patient and Doctor

Cambios al programa Medicaid de NC

Si usted recibe beneficios del programa Medicaid de Carolina del Norte, es posible que deba seguir algunos pasos.

MÁS INFORMACIÓN SOBRE EL PLAN ADMINISTRADO DE MEDICAID

If you receive benefits under North Carolina’s Medicaid program, you should know about upcoming changes.

Most enrollees must choose a health plan as the state shifts to managed care. Look for a letter from the state that tells you whether you are eligible for managed care.

NHRMC Physician Group patients can learn more about changes here.

 

 

 

 

Important Information About the State's New Medicaid Program

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, you can choose from health plans.

  • Each health plan has 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.
  • Each plan has its own network of qualified doctors and healthcare professionals.

When do these changes happen?

Managed Medicaid health plans became effective July 1.

  • Patients had until May 14, 2021, to select their health plan and primary care doctor.
  • If you did not choose a health plan and a doctor by May 14, one was chosen for you beginning May 15.
    • If you need to change your assigned Medicaid plan, you can do so within 90 days of your plans start date.
    • If you need to change your assigned primary care provider, you can do so within 30 days of your plans start date.

What do I need to do?

  • Review the plan you are enrolled with and familiarize yourself with its benefits.
  • Make sure your assigned primary care provider is correct.
  • Request any changes to your Medicaid plan or assigned primary care provider

Why am I unable to find my primary care provider in the online directory?

Health plans add new healthcare providers to their networks on a daily basis.

Please check the Medicaid and NC Health Choice Provider and Health Plan Lookup Tool again soon.

Who can I call to get help?

Call the enrollment site’s customer service center toll-free at 833-870-5500 (TTY: 833-870-5588). You may need your Medicaid ID number when you call.

If you speak a language other than English, the call center can still help you using a language assistance service.

How can I change my primary care provider?

If you did not select a primary care provider (PCP) by the enrollment date and were automatically assigned a PCP, you can change your PCP within 30 days from the date you receive your Medicaid card. After that, you can change you PCP one additional time every 12 months without cause or at any time with cause.  

To change your assigned PCP, you will need to contact your Medicaid plan servicer using the designated phone number below:  

  • AmeriHealth Caritas of NC
    1-855-375-8811
    24 hours a day, 7 days a week  
  • BCBS Healthy Blue
    1-844-594-5070
    7 a.m. – 6 p.m., Monday through Saturday
  • Carolina Complete
    1-833-552-3876
    7 a.m. – 6 p.m., Monday through Saturday  
  • United Healthcare NC Community Plan
    1-800-349-1855
    7 a.m. – 6 p.m., Monday through Saturday  
  • WellCare of NC
    1-866-799-5318
    7 a.m. – 6 p.m., Monday through Saturday  

More FAQs

See more frequently asked questions to learn about your Medicaid benefits as North Carolina transitions its program to managed care.

Eligibility for Medicaid Managed Care

Medicaid eligibility rules will remain unchanged at this time. If you have questions about eligibility, contact your local department of social services. Find contact information at ncdhhs.gov/localdss.