NC Medicaid (and NC Health Choice) is Changing!

Updated 25 Sept 2023

NC has finally expanded Medicaid! NC now allows online application for benefits including Medicaid, NC Health Choice and Food stamp. Please complete the ePASS application and then you can complete the rest of the interview by phone if you wish.  Online application for NC Medicaid/Food Stamps= ePASS

As of 25 September 2023 Sandhills Pediatrics is participating with Medicaid Health Plans Carolina Complete Health, Wellcare and NC Medicaid Direct. 

IF you are signed up with AmeriHealth Caritas, Healthy Blue, or United HealthCare Community Plan, and would like to see Sandhills Pediatrics, THEN please call the enrollment broker 1-833-870-5500  and ask to switch to Carolina Complete Health or Wellcare.  (with Sandhills Pediatrics as the PCP).  We can often see us while you are switching plans, please call us for details.

If your plan is Carolina Complete Health or Wellcare and your Primary Care Provider (PCP) is someone other than Sandhills Pediatrics and you us to be your child’s doctor, please call them and tell them you want to switch PCPs.

  • Carolina Complete Health 833-552-3876 and follow the prompts for member services
  • Wellcare 866-799-5318

You can also contact the enrollment broker to pick a plan at:

  • 833-870-5500 (TTY: 1-833-870-5588) Hours of operation: 7 a.m. to 8 p.m., Monday through Sunday

Our group NPI (National Provider Identifier) is 111-499-8150

Our central office address is: 195 W ILLINOIS AVE
SOUTHERN PINES, NC 28387-5808

Our primary care doctors are:

  • LINDSEY BELLAMY, DO
  • JOSEPH BOALS, MD
  • SARAH LOCKLEAR BREWINGTON, MD
  • SARAH CARR, MD
  • CHRISTOPH DIASIO, MD
  • NATALEE FRENCH, MD
  • FREDERICK HARRISON MABRY, MD
  • JENNIFER MABRY, MD
  • NORA “CATE” MASON, MD
  • SCOTT SEXTON, MD
  • REBECCA SIMPKIN, MD
  • WILLIAM “BILL” STEWART, MD

Our primary care NPs are:

  • NIKKI ETEO, CPNP
  • GWEN GARCIA-LEACH, CPNP
  • JESSICA HAYWOOD, FNP
  • ELIZABETH HODGIN, CPNP
  • AMY IVEY, CPNP
  • KIM NIEMEYER, CPNP
  • KAMERON SPERDUTO, CPNP
  • MATTHEW THOMPSON, MSN, FNP-C

FAQs

Medicaid Recertification

Medicaid is required to confirm members are still eligible for services- please make sure DSS/Medicaid has your most current address if they need more information.  NC Medicaid has more information here.

What should I do right now to get ready?

Please make sure your local DSS office has your current address!

If you can’t reach your county DSS, you can also call the Medicaid Contact Center 1-888-245-0179

Press 1 for English
Press 1 for English again
Press 1 if you currently have Medicaid.
Press 1 to change your healthcare provider.
If you want to be seen at any of the Sandhills Pediatrics offices, you can give the central office address at 195 West Illinois Ave, Southern Pines, NC 28387. 910-692-2244

If I get a letter saying my children stay in Medicaid Direct, do I need to do anything?

No

Why is this change happening to NC Medicaid and NC Health Choice?

The NC General Assembly passed the first of three medicaid transformation laws in 2015.  Link to Bill

Background from https://medicaid.ncdhhs.gov/transformation

“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 enrolled person to provide all services. The Department was on track to go live Feb. 1, 2020; however, new funding and program authority were required from the General Assembly to meet this timeline and Medicaid Managed Care was suspended in November 2019. In July 2020, legislation authorized the restart of Medicaid Managed Care transformation efforts with a July 1, 2021, launch date for Standard Plans “

NC Medicaid FAQ

Please let our staff know if you have any questions!