Donate to Hurricane Recovery

Home

What We Do

NC Medicaid (Division of Health Benefits) is dedicated to providing access to physical and behavioral health care and services to improve the health and well-being of over 2.1 million North Carolinians on behalf of the North Carolina Department of Health and Human Services. NC Medicaid manages the state's Medicaid and NC Health Choice health care programs, pharmacy benefits, and behavioral health services.

  • Medicaid is the program that provides health coverage to eligible low-income adults, children, pregnant women, seniors and people with disabilities. The program is jointly funded by North Carolina and the federal government.
  • NC Health Choice is our state’s name for the Children’s Health Insurance Program (CHIP). It provides health coverage to eligible children in addition to Medicaid. This program also is jointly funded by North Carolina and the federal government.
  • LME-MCOs are local management entities-managed care organizations that contract with NC Medicaid to provide behavioral health and intellectual/development disability services to Medicaid beneficiaries. 

In addition, NC Medicaid also oversees community alternatives programs for children and disabled adults, home health care, and helping people transition from nursing homes to live in their own communities—and more. It also works closely with the North Carolina Department of Justice to identify and prosecute fraud, waste and abuse of the Medicaid program. 

We are proud of our commitment to be good stewards of taxpayer money while continuing to provide valuable health programs and services to the Medicaid population. This is an enormous responsibility, one that we are honored to share with our state and local partners. At NC Medicaid, our staff comes to work each day knowing that our contributions make a real difference in the lives of North Carolinians and the communities in which we all live and work.

Notice about NC Medicaid Managed Care

With Medicaid Managed Care suspended, NC Medicaid will continue to operate under the current fee-for-service model administered by the Department. The Department will not decide on a new go-live date until it has program authority within a budget that protects the health and safety of North Carolinians and supports the Department's ability to provide critical oversight and accountability of Medicaid Managed Care.

  • Beneficiaries: Continue using Medicaid services as you do today. You do not need to enroll in a health plan at this time. Look for a notice to arrive in the mail with details. Call the Medicaid Contact Center at 888-245-0179 if you have questions about Medicaid Managed Care.

          Medicaid Managed Care Questions & Answers for Beneficiaries

  • Providers: Auto-assignment has been suspended; however, you should continue to contract with health plans. Call the Medicaid Contact Center at 888-245-0179 if you have questions about Medicaid Managed Care.
  • Procurement: Procurement efforts currently underway are expected to continue. There may be changes in the timing or schedule.

Background

In 2015, the NC General Assembly enacted legislation directing the Department to transition North Carolina Medicaid and NC Health Choice from fee-for-service to managed care. Under managed care, the state contracts with insurance companies, which are paid a predetermined set rate per person to provide all services. The Department was on track to launch managed care Feb. 1, 2020. New funding and program authority were required from the General Assembly to meet this timeline. The General Assembly adjourned in November 2019 without providing new spending and program authority required for the transition to managed care.