Medicaid Frequently Asked Questions

Some people will be in NC Medicaid Direct because it provides services that meet specific needs. For example, it provides the same services currently covered for developmental disability, behavioral health, traumatic brain injury and substance use disorder. To learn more about NC Medicaid Direct, call 1-888-245-0179. To ask to stay in NC Medicaid Direct, including your Local Management Entity-Managed Care Organization (LME-MCO), you must use our form.

Most people will not lose any services. All health plans must offer the same basic behavioral health services. But, some services are only offered through Medicaid Direct and the Eastern Band of Cherokee Indians (EBCI) Tribal Option.

Your health plan works with a provider network. A network is a group of doctors, hospitals and other health care providers who have an agreement with a health plan to give members medical care.

Each health plan has a network of doctors for regular visits and specialists when you need certain services, like physical therapy.

Call your health plan. You can also ask the doctor to join your health plan’s network.

If you have standing appointments, contact your chosen health plan to ask if they will still be covered. Call your health plan.

Use these questions to help you choose the best plan for you:

• Do you want to keep your current doctor or clinic? Or do you want a new one?
• Does the health plan have the doctors, hospitals and specialists you use?
• Does anyone in your family have special health needs?
• What added services does the plan have?
• What are the differences between the health plans?

All health plans are required to have the same Medicaid services, such as office visits, blood tests and X-rays. Health plans may also offer added services.

There are five health plans available. These include:

• WellCare
• UnitedHealthcare Community Plan
• HealthyBlue
• AmeriHealth Caritas
• Carolina Complete Health

The EBCI Tribal Option is a health plan for people who are federally recognized tribal members or qualify for Indian Health Services (IHS) and live in Cherokee, Haywood, Graham, Jackson or Swain County or in a neighboring county of the five-county region. The EBCI Tribal Option offers all Medicaid medical, behavioral, and pharmacy services. It addresses health issues common to Native Americans.

After you enroll, your health plan will mail you information and a new ID card. You will use this ID card to get health care services.

Yes. In the first 90 days, you can change your health plan for any reason. After that, unless you have a special reason, you cannot change your health plan until your Medicaid recertification date. Reasons are listed on the Health Plan Change Request form. For a copy of the form, go to Member resources at ncmedicaidplans.gov/member-resources

We will send you a letter telling you when you can choose a new health plan without a special reason. To learn more, call us toll free at 1-833-870-5500 (TTY: 1-833-870-5588). Or use the chat tool to chat with us online.

You may have to change your health plan when you have a life change. For example, you might have moved to a new home. Life changes can make a difference in your health plan choices. Contact your local department of social services and explain your change.

If you are enrolled in NC Medicaid Direct, call 1-888-245-0179. In NC Medicaid Direct, you may be able to get services from a Local Management Entity-Managed Care Organization (LME-MCO). View a list of NC Medicaid Direct behavioral health, I/DD and TBI services.To ask to stay in NC Medicaid Direct, including your LME-MCO, you must use our form.

If you enroll in a health plan through NC Medicaid Managed Care, you may not be able to get certain NC Medicaid Direct services. If you joined a health plan through NC Medicaid Managed Care and need certain services for developmental disability, behavioral health, TBI or substance use disorder, you may have more choices.

Yes. You can use the app to:

• Find and view primary care providers (PCPs) and health plans
• Choose a PCP
• Enroll (join a health plan)

You cannot use the app to apply for NC Medicaid.

Please have your NCID ready. You must sign in with your NCID to enroll using the app.

An NCID is a web-based application with a secure login. It gives you access to resources and your information. When you enroll online in NC Medicaid Managed Care, you will need to use your NCID signin. You can change your NCID username and password if you don’t remember them. If you don't have an NCID account, you will need to create one to enroll in NC Medicaid Managed Care online.

Paperless means you stop getting paper letters by mail and get them online instead. You can get an email, text message or both when you have a letter to view online. All of your letters will be online in your NC Medicaid Managed Care account.

Going paperless is faster than getting letters by mail. You can view the letters in your NC Medicaid Managed Care account as soon as they are ready, so you do not have to wait for the mail.

Going paperless is also easier. The letters in your NC Medicaid Managed Care account will never be removed, so you do not have to keep copies of letters mailed to you. You can go back to read them in your NC Medicaid Managed Care account at any time.

You may stop going paperless at any time. If you do, you will get letters by mail again.

There are 3 ways to apply:

• Apply for NC Medicaid online.
• Mail a paper application or drop it off at your local Department of Social Services (DSS).
• Apply in person at your local DSS.

Contact your local department of social services if you cannot apply one of these ways.

Learn more about how to apply for NC Medicaid.