Find a Doctor

As a Medicaid 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 transitioned to NC Medicaid Managed Care. Beneficiaries were able to choose a health plan and a primary care provider (PCP). Beneficiaries required to transition received a letter explaining how to transition to managed care. Beneficiaries were required to transition to NC Medicaid Managed Care if they:

  • Receive full benefits through the Family and Children’s or the Aged, Blind and Disabled Medicaid programs, or Medicaid for Pregnant Women program.
Tab/Accordion Items

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. Medicaid 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. Behavioral health covers mental health and substance abuse disorders.
Tab/Accordion Items

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. 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
    • Have both Medicare and Medicaid (dual eligible) 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. 
Tab/Accordion Items

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.
       

 

Column Paragraph

Find a Dentist

Find a Medicaid Dental Provider

Contact

NC Medicaid Contact Center
Phone: 888-245-0179

Local Division of Social Services Directory