Important Changes to NC Medicaid
North Carolina’s Medicaid program is changing. Private health plans will start managing care for most people with Medicaid and NC Health Choice (CHIP) coverage.
Four Important Things to Know:
- There is no change to who can get Medicaid. The same services will continue to be covered. However, which doctors you can go to will be limited and your health plan will decide whether to approve some services your doctor requests.
- Most people will have to choose a health plan and a doctor with that plan. If you don’t choose a plan, Medicaid will select a health plan and doctor for you.
- People who have serious mental illness or developmental disabilities, people who have Medicare, people in a Medicaid waiver program, and some others do not have to choose a health plan at this time.
- 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 information in your preferred language from NC Medicaid and health care services.
- 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 Managed Care and appeal if the request is denied.
- 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 at 877-201-3750 if you experience any problems.
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 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 or ncmedicaidplans.gov.
- Look for a letter telling you whether you have to enroll in a health plan.
- You can also contact the NC Medicaid Ombudsman if you need more information or assistance at 877-201-3750 or ncmedicaidombudsman.org.
(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 30, 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 free legal assistance by contacting one of these organizations:
Pisgah Legal Services – Apply Online
(Avery, Buncombe, Henderson, Jackson, Macon, Madison, Mitchell, Polk, Rutherford, Transylvania and Yancey counties)
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