Find a Doctor

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.
Click here to expand section for more information

Click here to expand section for more information

If  you are transitioning to NC Medicaid Managed Care and want to keep the PCP you have now: 

  • Choose a health plan that your provider works with. If you have questions about the instructions in the letter you received , 
    • Call 1-833-870-5500 (toll free),
    • Or go online at ncmedicaidplans.gov
    • You can ask your provider which health plans they work with,    
  • Then choose the provider you have now.
     

If you want to choose a different PCP, here are some things to think about:

  • Is there another provider you already like?
  • How far are you willing to travel to see a provider?
  • Do you need a provider who speaks a certain language?
  • Is the provider accepting new patients?
     

To find a doctor, go to Find a provider.   

  • If you know the provider by their last name, search by “Provider for a Plan.” Enter at least part of the last name and a location to search.
  • If you know the practice name where the provider works, search by “Organization for a Plan.”  Enter at least part of the practice (organization) name and a location to search.
  • If you know the health plan you want but do not know which provider you want to choose, go to search by “Health Plan for an Organization.”  Select your health plan in the “Health Plan” field, a location, and one other field (I.e. PCP only) to search.
  • If you are looking for a specific type of provider, select one or more of the other options offered before searching.  For example, to find a provider who speaks a certain language, choose one from the “Languages” field.
  • Or, if you have a PCP but want to find a specialist (allergy, cardiology, dermatology, and more), choose one from the “Specialty” field before searching.
  • Dental services are not offered through health plans but are still available to you.  For more information on how to find a dentist go here

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
Click here to expand section for more information

Click here to expand section for more information

If  you are transitioning to NC Medicaid Managed Care and want to keep the PCP you have now: 

  • Choose a health plan that your provider works with. If you have questions about the instructions in the letter you received , 
    • Call 1-833-870-5500 (toll free),
    • Or go online at ncmedicaidplans.gov
    • You can ask your provider which health plans they work with,    
  • Then choose the provider you have now.
     

If you want to choose a different PCP, here are some things to think about:

  • Is there another provider you already like?
  • How far are you willing to travel to see a provider?
  • Do you need a provider who speaks a certain language?
  • Is the provider accepting new patients?
     

To find a doctor, go to Find a provider.   

  • If you know the provider by their last name, search by “Provider for a Plan.” Enter at least part of the last name and a location to search.
  • If you know the practice name where the provider works, search by “Organization for a Plan.”  Enter at least part of the practice (organization) name and a location to search.
  • If you know the health plan you want but do not know which provider you want to choose, go to search by “Health Plan for an Organization.”  Select your health plan in the “Health Plan” field, a location, and one other field (I.e. PCP only) to search.
  • If you are looking for a specific type of provider, select one or more of the other options offered before searching.  For example, to find a provider who speaks a certain language, choose one from the “Languages” field.
  • Or, if you have a PCP but want to find a specialist (allergy, cardiology, dermatology, and more), choose one from the “Specialty” field before searching.
  • Dental services are not offered through health plans but are still available to you.  For more information on how to find a dentist go here

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. 
Click here to expand section for more information

Click here to expand section for more information

If you will continue to receive services as you do today, through NC Medicaid Direct and do not want to change your PCP, then you do not have to do anything.  

But, if you want to change your PCP you may: 

  • Call the Medicaid Contact Center at 888-245-0179, or
  • Call your local DSS Office, or
  • Go to Find a provider to see who is taking new patients.
    • If you know the provider by their last name, search by “Provider for a Plan.” Enter at least part of the last name and a location to search.
    • If you know the practice name where the provider works, search by “Organization for a Plan.” Enter at least part of the practice (organization) name and a location to search.
    • If you do not know the PCP you want to choose, go to Search by “Health Plan for an Organization.” Select “NC Medicaid Direct” in the Health Plan field, a location, and one other field (I.e. PCP only) to search.
    • If you are looking for a specific type of provider, select one or more of the other options offered before searching.  For example, to find a provider who speaks a certain language, choose one from the “Languages” field.
    • Or, if you have a PCP but want to find a specialist (allergy, behavioral health provider, cardiology, dentists, and more), choose one from the “Specialty” field before searching.
    • If you use this option to find a new PCP, you must still call the Medicaid Contact Center or your local DSS office to ask for the change.  Once made, you will receive a new card with the new PCP.
       

 

Contact

NC Medicaid Contact Center
Phone: 888-245-0179

Local Division of Social Services Directory