Changes to NC Medicaid: FAQ
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Do you need to choose a health plan?
As Medicaid transitions to managed care, you may need to choose a health plan. Use our new tool to find out! Major changes are coming to NC Medicaid. If you are currently enrolled in NC Medicaid or NC Health Choice (CHIP), you should get a letter telling you about these changes. Here is a list of Frequently Asked Questions to help you get started.
NEW resources added below 4/5/21
Frequently Asked Questions
What is changing?
NC Medicaid is moving to a new system called Managed Care. This means that private health insurance companies (instead of the state of NC) will start managing care for most people now using Medicaid. It will be free and will not change your eligibility for Medicaid.
As part of the new program, most people will have to choose a health care plan and primary care doctor. Your letter about these changes will include an enrollment package for the new program.
If you are now receiving Medicaid services through an LME/MCO, you probably will not have to choose a new plan.
Can I keep my doctor?
If you want to stay with your current doctor(s), make sure you choose the same plan they do. Some doctors may be out of network for certain plans. So, ask your doctor which health plan they are going with. This is the best way to make sure that your doctor will be in the plan that you select.
Do I have to sign up even if I already did it last year?
Are all the plans the same?
No. Each plan offers different services and bonuses, such as gym memberships, cell phone packages, smoking cessation, etc. It is important to look closely at each option so that you can find the one that is right for you.
How do I know which plan to sign up for?
If you already have doctors that you like, you should sign up for the plan that they are selecting. Before you sign up for a plan, call your favorite doctor and ask them which Medicaid Managed Care plan they will select. After that, you can choose the health plan that allows you to keep seeing your favorite doctor.
What is the deadline for choosing a plan?
The deadline to select a plan is May 14. If you do not select a plan by May 14, the State will pick one for you. We recommend selecting your own plan instead of letting the State do it for you. You can change plans later if you make a mistake, but it is best to pick the right plan from the start.
What is the Enrollment Broker?
The State knows this choice is hard for people, so there is a free service called an Enrollment Broker to help you. The Enrollment Broker can help you with:
- Looking up your Medicaid history to see if you need to switch to managed care.
- Understanding the details of the different health plans.
- Looking up what plan your doctor chose.
- Connecting you with the right plan for your needs.
How do I contact the Enrollment Broker?
1-833-870-5500 (TTY: 1-833-870-5588), 7am-5pm, Mon-Sat.
Visit the Enrollment Broker’s website. The website also has a live chat feature to help you. Or download the free app for iPhones and Android on the App store or Google play (Search NC Medicaid Managed Care).
Is there a live person on the Enrollment Broker line?
Yes, if you hit Option 3 when you call, you will get a live person.
When do the tailored plans start?
If you are now receiving Medicaid services through an LME/MCO, you probably will not have to move to Managed Care. Instead, you will have a choice: you may switch to Managed Care now or you may wait until July 2022 for a program called tailored plans.
Tailored plans will provide the same services as Standard Plans but will also provide additional specialized services that serve individuals with significant behavioral health conditions. If you decide to wait, you will be able to stay with your LME/MCO until then. If you are in the small group that has this choice to make, you can still contact the Enrollment Broker, who can help you know which choice is best for you.
What if I have been assigned to move to Managed Care, but I do not want to?
You can request to stay in NC Medicaid Direct but this will only be allowed for special situations. Learn more about the health plans and who will not need to choose a health plan at this time. If you have additional questions, call the Enrollment Broker.
Who do I call if I still have questions?
The best place to start with your questions is the Enrollment Broker. They have received extensive training on all the details of these changes, and about the plans. They will be able to answer your questions.
If you already spoke with the Enrollment Broker and you need more help, or have problems with the enrollment process, you can also call the NC Medicaid Ombudsman: 877-201-3750 or NCMedicaidOmbudsman.org. This service will not be available until April 15.
Important dates to remember:
March 15, 2020: Open enrollment begins. If you have questions before you enroll, call the Enrollment Broker: 1-833-870-5500 (TTY: 1-833-870-5588). 7am-5pm Mon-Sat.
May 14, 2021: Enrollment period ends
July 1, 2021: New health plans go into effect
Need more information?
View the NC Managed Care Fact Sheet to learn more about these changes and how they might affect your health care. You can also learn about your rights under Managed Care.
For all other questions, call the Enrollment Broker: 1-833-870-5500 (TTY: 1-833-870-5588). 7am-5pm, Mon-Sat.