Sample notices for beneficiaries about NC Medicaid.
Confirmation Notices
Managed Care Mandatory - Notice to beneficiaries who were enrolled in a Standard Plan
English | Spanish
Standard Plan Exempt (NC Medicaid Direct) - Notice to beneficiaries who were enrolled in a Standard Plan and may choose NC Medicaid Direct
English | Spanish
NC Medicaid Direct (Standard Plan Exempt) - Notice to beneficiaries who were enrolled in NC Medicaid Direct and may choose a Standard Plan
English | Spanish
Standard Plan Exempt (NC Medicaid Direct) - Plan Change - Notice to beneficiaries who were enrolled in a new Standard Plan and may choose NC Medicaid Direct
English | Spanish
Standard Plan (EBCI Tribal Option and NC Medicaid Direct) - Notice to federally recognized tribal member or IHS-eligible beneficiary who were enrolled in a Standard Plan and can choose or change their Standard Plan or choose the EBCI Tribal Option or NC Medicaid Direct
English | Spanish
NC Medicaid Direct (EBCI Tribal Option and Standard Plan) - Notice to federally recognized tribal member or IHS-eligible beneficiary who were enrolled in NC Medicaid Direct and can choose the EBCI Tribal Option or a Standard Plan
English | Spanish
EBCI Tribal Option (Standard Plan and NC Medicaid Direct) - Notice to federally recognized tribal member or IHS-eligible beneficiary enrolled in the EBCI Tribal Option and can choose a Standard Plan or NC Medicaid Direct
English | Spanish
NC Medicaid Direct - LME/MCO - Notice to beneficiaries who were enrolled in NC Medicaid Direct and have an LME/MCO
English | Spanish
NC Medicaid Direct - No LME/MCO - Notice to beneficiaries who were enrolled in NC Medicaid Direct and do not have an LME/MCO
English | Spanish
Transition Notices
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 Care Management Assignment
English l Spanish
Medicaid Recertification Reminder
English l Spanish
Family Planning Program Benefit Change Notice (Child in Home)
English | Spanish (see page 2 of notice)
This page was last modified on 09/18/2023