NC Medicaid (and NC Health Choice) is Changing!

UPDATED 12/8/2019 Instead of a single medicaid program run by NC state government, private insurance Managed Care companies will be processing the medicaid and NC Health Choice claims as well as the current system of medicaid which will now be renamed NC Medicaid Direct.

NC DHHS announced the transition is ON HOLD 11/3/2019

From DHHS:

Nov 19, 2019
The North Carolina Department of Health and Human Services today announced that because the NC General Assembly did not take needed action, managed care implementation and open enrollment for NC Medicaid must be suspended. The General Assembly adjourned last week without providing required new spending and program authority for the transition to managed care. Managed care will not go live on Feb. 1, 2020. With managed care suspended, NC Medicaid will continue to operate under the current fee-for-service model administered by the department. Nothing will change for Medicaid beneficiaries; they will get health services as they do today. Behavioral health services will continue to be provided by Local Management Entities/Managed Care Organizations. All health providers enrolled in Medicaid are still part of the program and will continue to bill the state through NCTracks. Open enrollment had begun for part of the state in July and launched statewide in October. The North Carolina Enrollment Broker Call Center (833-870-5500) will stay open through Dec. 13, 2019 to answer questions but will no longer enroll beneficiaries in a health plan. Beneficiaries can continue to contact the Medicaid Contact Center (888-245-0179). Notices will be sent to beneficiaries informing them to continue accessing health services as they do now, rather than through new health plans. The suspension of work and the wind-down process will begin tomorrow. Once suspended, managed care cannot easily or quickly be restarted. The department will not decide on a new go-live date until it has program authority within a budget that protects the health and safety of North Carolinians and supports the department’s ability to provide critical oversight and accountability of managed care. Both the conference and transformation mini budgets passed during this year’s legislative session and vetoed by Governor Roy Cooper left the department vulnerable to an unprecedented cut that would have had a crippling effect on its ability to provide services that protect people’s health and safety and moved the department out of Raleigh to Granville County. In addition, neither expanded Medicaid so that hardworking North Carolinians could afford access to health coverage. Background In 2015, the NC General Assembly enacted legislation directing DHHS to transition Medicaid and NC Health Choice from fee-for-service to managed care. Under managed care, the state contracts with insurance companies, which are paid a predetermined set rate per person to provide all services. The department was on track to go live Feb. 1, 2020. New funding and program authority was required from the General Assembly to meet this timeline. 

FAQs from DHHS

For now, Medicaid will not move to new health plans. As a Medicaid beneficiary, you keep getting Medicaid care and services the way you do now. Your primary care provider (PCP) stays the same. You do not need to choose a Medicaid Managed Care health plan at this time. When will Managed Care restart? When will my health plan start? For now, the move to new health plans is on hold. We will tell you when it restarts and when you will be able to choose a health plan. Does this change my Medicaid coverage? No. Your coverage will stay the same. You will keep getting your Medicaid care and services the way you do now. Your primary care provider (PCP) stays the same. Do I need to do anything right now? Do I need to still choose a health plan?  No. You do not need to do anything right now. You do not need to choose a health plan. You will keep getting your Medicaid care and services from the State the way you do now. Can I still see my doctor? Yes. You can go to your same primary care provider (PCP) and specialists you see today. Your PCP is listed on your Medicaid card. If you have any questions, call the Medicaid Contact Center at 1-888-245-0179. Who do I go to for Behavioral Health Intellectual/Developmental Disability (I/DD) benefits? Should I still go to my Local Management Entities - Managed Care Organizations (LME-MCOs)? Yes. If you are currently receiving services from an LME-MCO, you will continue to get those services. What if my Medicaid coverage is set to end before Managed Care restarts? If your coverage is set to end before Managed Care restarts, your Medicaid coverage will go through the same yearly eligibility review and recertification process used today. What if I already chose a health plan? We will save your health plan choice. When Medicaid health plans restart, you will have an opportunity to change your health plan if you choose. Do I still need to enroll in a health plan while Managed Care is on hold? Can I still choose a health plan? No. You cannot choose a health plan or PCP for a health plan now. The State will tell you when Managed Care restarts. You will be asked to choose a health plan then. Why was Managed Care delayed? Why did this happen? Due to ongoing state budget issues, Medicaid health plans cannot start at this time. Will Managed Care ever restart/happen? For now, the move to new health plans is on hold. We will tell you when it restarts and when you will be able to choose a health plan. What is the status of the form I submitted (Raise Your Hand)? For now, no form is needed.  The forms submitted are not being reviewed during the Medicaid Managed Care suspension. If you currently receive services from LME-MCOs, you will continue to get service from them. If you have NC Medicaid and there are behavioral health services that you need, talk to your LME-MCO. If you have NC Health Choice, are calling for a child that is age three or younger, or are a legal non-citizen, contact Beacon Health at 1-888-510-1150. Where should I check for updates on what is happening with Medicaid and Managed Care? Visit for the latest information. We will tell you when the move to health plans restarts and when you will be able to choose a health plan. How does this announcement affect the rollout of Managed Care benefits to the Tribal population? At this time, the Department is planning to introduce the Eastern Band of Cherokee Indians (EBCI) Tribal Option beginning in July 2021. Will the same plan options be available in the future?  The Department expects the same plan options will be available in the future. The Department will let beneficiaries know if there are any changes to their health plan options.
The main website is located at The most important thing you can do until open enrollment opens again is to make sure your address is up to date with your local county DSS! Please let our staff know if you have any questions!

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