Managed Medicaid

If you receive benefits under North Carolina Medicaid, you should know about changes to the program in 2021. Most enrollees must now join a NC Medicaid Managed Care plan. If you are eligible, you will receive a letter from the state advising you of next steps.

What is NC Medicaid Managed Care?

The goal of NC Medicaid Managed Care is to help 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.

° See a list of added services by health plan visit.

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

When do these changes happen?

Your new health plan becomes effective July 1. 

  • Open enrollment (where you choose your plan and doctor) continues through May 14.
  • If you do not choose a health plan and a doctor by May 14, one will be chosen for you beginning May 15.
  • You have until Sept. 30 to change your health plan for any reason.

What do I need to do?

  • Choose a primary care provider (PCP). That can be a doctor, physician assistant or nurse practitioner.
    • Visit ncmedicaidplans.gov/.
    • Use the NC Medicaid Managed Care mobile app.
    • Call toll free 833-870-5500 (TTY: 833-870-5588).
  • Choose a health plan.
  • Enroll in a plan.
    • Chat with an enrollment specialist at ncmedicaidplans.gov.
    • Use the NC Medicaid Managed Care mobile app.
    • Call toll-free 833-870-5500 (TTY: 833-870-5588).
    • Fill out and mail or fax in a paper enrollment form you’ll receive in the mail.
  • If you do not choose a health plan, one will be chosen for you.
    • You know your healthcare needs, so it’s better if you choose.
  • Watch a video that explains what you need to do.

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.

Key dates for transitioning to Medicaid Managed Care

  • March 15, 2021 – open enrollment for beneficiaries begins
  • May 14, 2021 – open enrollment ends
  • May 15, 2021 – auto-enrollment beings for beneficiaries who have not selected a health plan
  • July 1, 2021 – Medicaid Managed Care launch
  • September 30, 2021 – deadline to make a health plan change
  • Changes to PCP can be made twice a year for any reason

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/localds.