Charlotte Center for Legal Advocacy supports the work of the NC Medicaid Ombudsman.
What is the NC Medicaid Ombudsman?
The NC Medicaid Ombudsman is a free, confidential service that can answer your questions about Medicaid Managed Care, and help you solve problems with your coverage and care. The NC Medicaid Ombudsman can tell you your rights under Medicaid Managed Care, and refer you to a legal aid organization if your rights are being denied. They also connect people to resources like legal aid, social services, housing resources, food assistance and other programs.
The Ombudsman can help you get the care you need, if:
The Ombudsman can help you change what care you can access, if:
The Ombudsman can help you with barriers to care and coverage, if:
Medicaid Managed Care – a big change for many with Medicaid
If you depend on North Carolina Medicaid, the way you receive health care from your doctors and health care providers may have changed. The State has transitioned most Medicaid recipients to Medicaid Managed Care to provide you with care that addresses your health needs and reduces the high cost of health care.
The transition to Medicaid Managed Care is complicated. Your unique health care situation includes different doctors, nurses, therapists and services like transportation that should work together. When these things are interrupted, it takes getting used to.
You have rights and the NC Medicaid Ombudsman can help!
Health plans – how they work, what to do if they don’t
Before July 1, 2021, you could work directly with your doctor (or pharmacist) to know if they accepted NC Medicaid for check-ups and other services (or prescriptions). You could also check with Medicaid to learn about other services or where to go for a medical emergency.
With Medicaid Managed Care, most Medicaid recipients now have health plans managed by private companies that work with specific doctors and may offer additional services. Not all doctors work with all health plans and some require advance notice to approve a service.
It is up to you to understand which doctors and services are covered as part of your health plan. Your doctor’s office may not be familiar with your health plan or what is or is covered, so it is best to communicate with someone at your health plan directly.