NC Medicaid Managed Care

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Under NC Medicaid Managed Care, beneficiaries will receive the same Medicaid services they do today but in a new way. Instead of one Medicaid program there are multiple health plans to choose from. In a health plan, a group of doctors and other providers work together to give patients the healthcare they need. Physical health, mental health, and medicine will come from the same plan. In addition to current Medicaid services, health plans may offer added services such as programs to help you eat healthier or quit smoking. To learn about the basic benefits and services that all health plans offer—as well as services that are not covered—go to Medicaid health plan benefits and services. 

Beneficiaries will also choose a primary care provider (PCP). A PCP could be a family doctor, clinic, or other healthcare provider. To keep their doctor, clinic or other provider, beneficiaries should find out which health plans their providers work with and then choose one of those plans. 

NC Medicaid Managed Care will send beneficiaries a letter telling them if they must enroll. They can also call toll free at 1-833-870-5500 (TTY: 1-833-870-5588).

  • 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 plan but have the option to do so.
  • A small number of people will not choose a health plan because of the type of health services they need. They will stay enrolled in NC Medicaid Direct. 

To learn more about Medicaid Managed Care, who must choose a health plan, and how to enroll, please visit the site for NC Medicaid Plans. 

Managed Care Enrollment Timelines

Below are enrollment dates for beneficiaries transitioning to Standard Plans under Medicaid Managed Care. Medicaid Managed Care open enrollment for Phase 1 counties has been extended to coincide with open enrollment of Phase 2 counties. There will be one statewide implementation date on February 1, 2020. NC DHHS will coordinate with DSS and others to ensure Beneficiaries in Regions 2 and 4 know they have more time to enroll with a Prepaid Health Plan (PHP) and select a Primary Care Provider (PCP).

Please visit https://www.ncmedicaidplans.gov for updates.

Beneficiaries with more specialized behavioral and health needs will transition to tailored plans that will be procured in mid-2021. Until that time, those beneficiaries will continue receiving services from Medicaid Direct and the LME-MCO.

Milestone

Phase 1

(Regions 2, 4)

Phase 2

(Regions 1, 3, 5, 6)

Enrollment Packets Mailed

6/28/2019

10/1/2019

Open Enrollment Begins

7/15/2019

10/14/2019

Open Enrollment Ends

12/13/2019

Auto-Assignment

12/16/2019

Health Plan Effective Date

2/1/2020

* Dates are approximate and subject to change.

Source: Medicaid Managed Care Update, NC DHHS Secretary Mandy Cohen, M.D., September 4, 2019

Open enrollment for Beneficiaries in Regions 2 and 4 begins July 15, 2019.

Open enrollment for Beneficiaries in Regions 1, 3, 5, and 6 begins October 14, 2019.

Health plan coverage for all regions begins February 1, 2020. 

Region 1

 

Region 2

 

Region 3

 

Region 4

 

Region 5

 

Region 6

Avery

 

Alleghany

 

Alexander

 

Alamance

 

Bladen

 

Beaufort

Buncombe

 

Ashe

 

Anson

 

Caswell

 

Brunswick

 

Bertie

Burke

 

Davidson

 

Cabarrus

 

Chatham

 

Columbus

 

Camden

Caldwell

 

Davie

 

Catawba

 

Durham

 

Cumberland

 

Carteret

Cherokee

 

Forsyth

 

Cleveland

 

Franklin

 

Harnett

 

Chowan

Clay

 

Guilford

 

Gaston

 

Granville

 

Hoke

 

Craven

Graham

 

Randolph

 

Iredell

 

Johnston

 

Lee

 

Currituck

Haywood

 

Rockingham

 

Lincoln

 

Nash

 

Montgomery

 

Dare

Henderson

 

Stokes

 

Mecklenburg

 

Orange

 

Moore

 

Duplin

Jackson

 

Surry

 

Rowan

 

Person

 

New Hanover

 

Edgecombe

Macon

 

Watauga

 

Stanly

 

Vance

 

Pender

 

Gates

Madison

 

Wilkes

 

Union

 

Wake

 

Richmond

 

Greene

McDowell

 

Yadkin

 

 

 

Warren

 

Robeson

 

Halifax

Mitchell

 

 

 

 

 

Wilson

 

Sampson

 

Hertford

Polk

 

 

 

 

 

 

 

Scotland

 

Hyde

Rutherford

 

 

 

 

 

 

 

 

 

Jones

Swain

 

 

 

 

 

 

 

 

 

Lenoir

Transylvania

 

 

 

 

 

 

 

 

 

Martin

Yancey

 

 

 

 

 

 

 

 

 

Northampton

 

 

 

 

 

 

 

 

 

 

Onslow

 

 

 

 

 

 

 

 

 

 

Pamlico

 

 

 

 

 

 

 

 

 

 

Pasquotank

 

 

 

 

 

 

 

 

 

 

Perquimans

 

 

 

 

 

 

 

 

 

 

Pitt

 

 

 

 

 

 

 

 

 

 

Tyrrell

 

 

 

 

 

 

 

 

 

 

Washington

 

 

 

 

 

 

 

 

 

 

Wayne

 Six Managed Care Regions in North Carolina

Source: Fact Sheet 2 Introduction to Medicaid Transformation: Part 2 - Enrollment & Timelines, May 21, 2019

For Beneficiaries – Whom to Contact

About Medicaid Eligibility:

Contact your local DSS Office. Find contact information at www.ncdhhs.gov/localdss.

About NC Medicaid Direct Benefits and Claims:

Call the Medicaid Contact Center toll free at 1-888-245-0179

About choosing a Health Plan or Primary Care Provider:

Go to www.ncmedicaidplans.gov (online chat is available).

Use the NC Medicaid Managed Care App.

Call 1-833-870-5500 (toll free) TTY 1-833-870-5588

About NC Medicaid Managed Care Plan or Benefits (after enrollment):

Contact your health plan 

Detailed Beneficiary Q&A documents are available in English and Spanish.

Health Plan Information

Beneficiaries can obtain more information in English and Spanish about Medicaid Managed Care and the enrollment process at NC Medicaid Plans. The site also contains:

  • Health plan comparison charts and lists of benefits
  • Provider network search capability
  • Program information, brochures, and enrollment forms
  • Questions and answers
  • Lists of events in each county

Enrollment Specialists are available via a chat tool to answer questions.

The links below provide information about services offered by each plan.

WellCare                                                           1-866-799-5318 (TTY: 711) 

UnitedHealthcare Community Plan       1-800-349-1855 (TTY: 711) 

HealthyBlueNC                                               1-844-594-5070 (TTY: 711) 

AmeriHealth Caritas NC                             1-855-375-8811 (TTY: 1-866-209-6421) 

Carolina Complete Health                        1-833-552-3876 (TTY: 711 or 1-833-552-2962)  

Carolina Complete Health will be available in Phase 2 starting on October 14, 2019 and will only be offered to people who live in these counties: Alexander, Anson, Bladen, Brunswick, Cabarrus, Catawba, Cleveland, Columbus, Cumberland, Gaston, Harnett, Hoke, Iredell, Lee, Lincoln, Mecklenburg, Montgomery, Moore, New Hanover, Pender, Richmond, Robeson, Rowan, Sampson, Scotland, Stanly, Union 

Resources for Local Management Entity-Managed Care Organization Beneficiaries

Some beneficiaries who currently receive services from Local Management Entities-Managed Care Organizations (LME-MCOs) may be required to enroll with a PHP while enrollment with a PHP will be optional for others.

NC Medicaid Transformation Q&A

Cardinal Innovations held a series of town hall meetings in July 2019 to address questions and concerns from LME-MCO members, families, and providers. Please visit the Cardinal website to review responses to questions raised during the town halls. Cardinal has also compiled an overview about Medicaid Tailored Plans.

Consumer and Family Advisory Committees

When reviewing health plan materials, beneficiaries may also want to consult other resources from their LME-MCO and their region’s Consumer and Family Advisory Committee (CFAC) to ensure they are fully informed when making choices among providers and health plans.

CFACs help identify service gaps, recommend needed services, and discuss service issues in the local behavioral health system. Please visit the links below for meeting minutes and upcoming meetings for Sandhills Center and Cardinal Innovations CFACs.

Requesting to Stay with LME-MCO and Medicaid Direct

As explained in this July 2019 memo, NC DHHS has issued eligibility and enrollment policy updates due to concerns that some beneficiaries assigned to Standard Plans would be better served by staying with Medicaid Direct (fee-for-service) and the LME-MCO. Please visit the following pages for:

For those who disagree with decisions related to their managed care, a NC Justice Center publication in  English andSpanish explains beneficiary rights and provides contact information for free legal resources.