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Medicaid Transformation in NC

North Carolina’s Medicaid program is changing. The state has contracted with private health insurance companies to manage health care for most N.C. residents who receive health coverage through Medicaid and NC Health Choice (CHIP). Find out what you need to know to prepare your family or your patients for these changes.

Questions? Find out what you need to know to make the most out of these changes for you and your family. Contact Charlotte Center for Legal Advocacy for help.
Becca Friedman (English)
Johanna Parra (Spanish)

Five things to know:

  1. There is no change to who can get Medicaid. The same services will continue to be covered, including hospitalizations, check-ups, prescriptions and more. However, which doctors you can go to will be limited and your health plan will decide whether to approve some services your doctor requests.
  2. Most people will have to choose a health plan and a doctor with that plan, unless they are in certain populations that are exempt or excluded. If you don’t choose by May 14, 2021, Medicaid will choose a health plan and doctor for you.
  3. People who have serious mental illness or developmental disabilities, people who have Medicare coverage, people in a Medicaid waiver program, and some others do not have to choose a health plan at this time.
  4. Enrollment will run from March 15 through May 14 and coverage under new health plans will begin July 1, 2021. 

What are your rights under managed care?

Get free advice in your preferred language from NC Medicaid and health care services about whether you are exempt or excluded and learn about which plan is the best choice for you and your family. 

Switch plans for any reason within 90 days of coverage starting with the first plan, or for good reason at any time. 

Request not to enroll in Medicaid Managed Care (meaning you would be able to choose to stay in fee-for-service Medicaid, also known as Medicaid Direct) and appeal if the request is denied.

Continue receiving the same NC Medicaid coverage and services you currently receive.

Get out-of-network care if medically necessary services are not available in your health plan’s network.

Have no interruption of care when moving in or out of managed care or between plans. 

Appeal if your health plan denies, reduces or stops coverage for health care you need.

Contact the NC Medicaid Ombudsman beginning April 15th, 2021 at 877-201-3750 if you experience any problems.

What you can do to prepare

Make sure your local Department of Social Services (DSS) has your current mailing address, phone number and email address so you can receive all important notices about this change.

Get free advice over the phone from NC Medicaid about whether you have to enroll and if so, learn which plan is best for you and your family. You can contact NC Medicaid at 833-870-5500 (TTY: 1-833-870-5588) or ncmedicaidplans.gov.

Use the free NC Managed Care mobile app to stay informed. Find the app by searching for “NC Medicaid Managed Care” on Google Play or the App Store.

Look for a letter telling you whether you have to enroll in a health plan.

Starting April 15, 2021, you can also contact the NC Medicaid Ombudsman if you need more information or assistance at 877-201-3750 or ncmedicaidombudsman.org.

Important dates

(Please note these dates are subject to change.)

March 1, 2021: Packets about changes to Medicaid program should have been mailed out to current Medicaid/CHIP recipients

March 15, 2021: Beneficiaries can begin signing up for managed care plans, also known as Prepaid Health Plans/PHPs. Open Enrollment lasts 60 days and ends December 13.

May 14, 2021: Deadline to enroll in a plan.

May 15, 2021: Auto-assignment begins for those who did not enroll in a Prepaid Health Plan.

July 1, 2021: Coverage under new Prepaid Health Plans begins. Beginning today, beneficiaries have 90 days (through September 30, 2021) to change their plans for any reason.

September 29, 2021: End of 90-day period for beneficiaries to change their Prepaid Health Plan for any reason.

Disagree with a Decision Related to Your NC Medicaid Care?

Get legal assistance and learn about your rights under NC Medicaid by contacting one of these organizations:

Charlotte Center for Legal Advocacy
(Cabarrus, Mecklenburg and Union counties)
1-980-265-3712 | charlottelegaladvocacy.org

Disability Rights NC
(statewide for people living with disabilities)
1-877-235-4210 | disabilityrightsnc.org

Legal Aid of NC
(statewide except for counties served by Charlotte Center for Legal Advocacy and Pisgah Legal Services)
1-866-219-LANC (5262) | legalaidnc.org

Pisgah Legal Services
(Avery, Buncombe, Henderson, Jackson, Macon, Madison, Mitchell, Polk, Rutherford, Transylvania and Yancey counties)
1-800-489-6144 | pisgahlegal.org

Additional Resources:

NC Managed Care: What’s Going On?
NC Medicaid One Pager (Eng)
NC Medicaid One Pager (Esp)

NC Medicaid Beneficiary Portal

NC DHHS Medicaid Transformation

CLASP Presentation: Immigrant Access to Health Care in NC

Charlotte Center for Legal Advocacy Family Support & Health Care Services (Eng)
Charlotte Center for Legal Advocacy Family Support & Health Care Services (Esp)
Charlotte Center for Legal Advocacy Health Insurance Navigator