Sample notices for beneficiaries about NC Medicaid.

Transition Notices 

Tailored Plan Mandatory - Notice to beneficiaries who were enrolled in the Tailored Plan. 
English l Spanish

Tailored Plan (Standard Plan) - Notice to beneficiaries who were enrolled in the Tailored Plan and can choose a Standard Plan. 
English l Spanish

Tailored Plan (NC Medicaid Direct) - Notice to beneficiaries who were enrolled in NC Medicaid Direct and can choose the Tailored Plan or stay in NC Medicaid Direct.
English l Spanish

Tailored Plan (Standard Plan, NC Medicaid Direct) - Notice to beneficiaries who were enrolled in another health care option and can choose the Tailored Plan, a Standard Plan or stay in NC Medicaid Direct. 
English l Spanish

Tailored Plan (EBCI Tribal Option, NC Medicaid Direct) - Notice to federally recognized tribal member or IHS-eligible beneficiary who was enrolled in another health care option and can choose the Tailored Plan, EBCI Tribal Option or NC Medicaid Direct
English l Spanish

Tailored Plan (EBCI Tribal Option, Standard Plan, NC Medicaid Direct) - Notice to federally recognized tribal member or IHS-eligible beneficiary who was enrolled in another health care option and can choose the Tailored Plan, a Standard Plan, EBCI Tribal Option or NC Medicaid Direct.  
English l Spanish

Enrollment Packet

Services Covered Outside Health Plans
English l Spanish

Drug List and Copays Insert 
English l Spanish

Health Care Option Guide 
English l Spanish

Enrollment Form - Standard Plan 
English l Spanish

Enrollment Form - Tailored Plan
English l Spanish

Enrollment Form – Exempt Tribal 
English l Spanish

Tailored Plan - Disenrollment Rights Insert - Version 1 
English l Spanish

Tailored Plan - Disenrollment Rights Insert - Version 2 
English l Spanish

Appeals and Grievances

Grievance Acknowledgement Notice
English l Spanish

Grievance Resolution Notice 
English l Spanish

Other Beneficiary Notices

Tailored Plan Delay Notice
English | Spanish

Tailored Care Management Assignment 
English l Spanish

Medicaid Recertification Reminder 
English l Spanish