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As a Medicaid or NC Health Choice beneficiary, you fall into one of three categories:

NC Medicaid Managed Care – Mandatory 

To learn more about NC Medicaid Managed Care, go to the NC Medicaid Managed Care Website
Most beneficiaries receiving Medicaid or NC Health Choice will be required to transition to NC Medicaid Managed Care. This means you must choose a health plan and a Primary Care Provider (PCP). If you must choose, NCDHHS - Division of Health Benefits will send you a letter that tells you how to transition to Managed Care. You will be required to transition to NC Medicaid Managed Care if you:

  • Receive full benefits through the Family and Children’s or the Aged, Blind and Disabled Medicaid programs, or through the NC Health Choice or Medicaid for Pregnant Women program.

NC Medicaid Managed Care – Exempt 

Some beneficiaries can choose to stay in NC Medicaid Direct. This means you are not required to choose a health plan and a PCP. NCDHHS - Division of Health Benefits will send you a letter that tells you if you have the choice to enroll. You have the option to choose a health plan if you:

  • Are a federally-recognized tribal member or individual eligible for services through Indian Health Service (IHS).    
  • Need certain services to address needs related to developmental disability, behavioral health or traumatic brain injury. BH covers MH and SUD

NC Medicaid Managed Care – Excluded (NC Medicaid Direct)    

  • Some beneficiaries will remain in NC Medicaid Direct, which is the “fee-for-service” program. This is how you receive health care services now. This means you cannot choose a health plan and you do not need to choose a new PCP unless you want to change to your current PCP. You will stay in NC Medicaid Direct if you:

    • Receive Family Planning Medicaid, Refugee Medicaid, Foster Care/Adoption Medicaid , or must meet a deductible before getting Medicaid benefits
    • Are part of the Health insurance premium payment (HIPP) or Program of all-inclusive care for the elderly (PACE) programs, or
    • Have both Medicare and Medicaid or receive long-stay nursing home services, 
    • Receive Innovations Waiver services, Traumatic Brain Injury (TBI) Waiver services, or Community Alternatives Program for Children (CAP/C) or Community Alternative Program for Disabled Adults (CAP/DA) services. 

Contact

NC Medicaid Contact Center
Phone: 888-245-0179

Local Division of Social Services Directory