North Carolina Medicaid has contracted with private health plans to manage care for most people with Medicaid and NC Health Choice (CHIP) coverage. Here are four important things you need to know.
- There is no change to who can get Medicaid, and the same services will continue to be covered, including hospitalizations, check-ups, prescriptions, and more. But now, your health plan will decide whether to approve the services your doctor requests.
- You will have to choose a health plan and a doctor to provide your health care, unless you are exempt. If you don’t, Medicaid will choose a health plan and doctor for you.
- People who have serious developmental disabilities or mental illness, persons who have Medicare, persons in a Medicaid waiver program, and some others are “exempt” and do not have to choose a health plan.
- Enrollment will begin this summer, and will be phased in throughout new NC Medicaid Managed Care Regions in the state.
What are Your Rights Under Managed Care?
- Get free advice over the phone from NC Medicaid about whether you are exempt and, if not, learn which plan is the best choice for you and your family. You have the right to receive information from NC Medicaid and health care services in your preferred language for free.
- Switch plans for any reason within 90 days of being enrolled, or for “good cause” at any time during the year.
- Request an “exemption” from NC Medicaid Managed Care and appeal if the exemption is denied.
- Continue to receive the same NC Medicaid coverage and services you receive now.
- Get out-of-network care if medically necessary services are not available in the health plan’s network.
- No interruption of care when transitioning between plans or out of managed care.
- Appeal if your health plan denies, reduces, or stops coverage for health care you nee
What Do I Need to Do?
- Make sure your local Department of Social Services (DSS) has your current mailing address, phone number, and email address so you receive all important notices about this change.
- Visit NC Medicaid at ncmedicaidplans.gov or call 1-833-870-5500 (TTY: 1-833-870-5588) to learn more. You can also use the NC Medicaid Managed Care mobile app to stay up to date. To get the free app, search for NC Medicaid on Google Play or the App Store.
July 2019 (or later)
- Look for a letter telling you to enroll in a health plan.
- Contact NC Medicaid to ask if you are exempt. If you are not exempt, ask NC Medicaid to help you choose your preferred health plan and doctor.
- If you live in Region 2 (the Triad area around Greensboro, High Point, Winston-Salem) or Region 4 (the Triangle area around Chapel Hill, Durham, Raleigh), you will enroll in an NC Medicaid health plan starting July 2019. For all other regions, enrollment starts October 1, 2019.
Disagree with a Decision Related to Your NC Medicaid Care?
Get free legal assistance by contacting one of the following organizations:
Disability Rights NC
(Statewide for persons with disabilities)
1-877-235-4210 | www.disabilityrightsnc.org
Legal Aid of NC
(Statewide except counties served by Charlotte and Pisgah Legal groups below)
1-866-219-LANC (5262) | www.legalaidnc.org
Charlotte Center for Legal Advocacy
(Cabarrus, Mecklenburg, and Union counties)
1-800-438-1254 | www.charlottelegaladvocacy.org
Pisgah Legal Services
(Buncombe, Henderson, Madison, Mitchell, Polk, Rutherford, Transylvania, and Yancey counties)
1-800-489-6144 | www.pisgahlegal.org